Denial of Suicide Attempt Among Hospitalized Survivors of a Self-Inflicted Gunshot Wound

McClay, Michael M.; O’Connor, Stephen S.; Groh, Brittany; Baudino, Marissa N.; Venanzi, Lisa; Shields, Angela; Wilson, Jo Ellen; Bone, John; Nicolson, Stephen E.

doi:10.1176/appi.ps.201700130

Cited by 6 publications

(4 citation statements)

References 22 publications

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“…17 Furthermore, intentional self-harm firearm injuries are rarely to the upper extremity, especially the upper extremity alone. 18 This led us to believe that many self-inflicted accidental injuries were being coded as “suicide/self-inflicted injury.” We tested this by quantifying the “suicide/self-inflicted injury” and “intentional self-harm” data by year. Between 2007 and 2014, there were over 2000 cases per year coded “suicide/self-inflicted injury.” In 2016 and 2017, there were fewer than 100 cases per year coded “intentional self-harm.” Based on this, we have presented results to identify these coding issues.…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Epidemiology of Upper Extremity Firearm Injuries among Major Trauma Hospitals in the United States

Hooper

Shauver

Chou

et al. 2021

Plastic &Amp; Reconstructive Surgery

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he United States is a country with more guns than people. 1 Approximately one-third of U.S. residents are gun owners, and firearms are currently the second leading cause of injury death among citizens younger than 24 years. 2,3 The majority of firearm injury studies focus on mortality; firearm morbidity, however, is also devastating on individual and societal levels. More than 80,000 nonfatal firearm injuries are treated in U.S. emergency departments each year, the cost of which totals over $700 million annually in inpatient care. In addition, many will require rehabilitation and long-term care. 4,5 Among firearm-related injuries, 24 to 34 percent affect the upper extremity, and these injuries are more likely to be accidental. 2,6 Hutchinson et al. reported that 81 percent of upper extremity firearm-related injuries were accidental self-inflicted injuries that occurred in the context of cleaning or loading a gun; still, assault and intentional self-harm are also responsible for a number of upper extremity firearm injuries. 2,7

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Epidemiology of Upper Extremity Firearm Injuries among Major Trauma Hospitals in the United States

Hooper

Shauver

Chou

et al. 2021

Plastic &Amp; Reconstructive Surgery

View full text Add to dashboard Cite

show abstract

“…In a review by Luoma et al, the authors identified that further measures were needed to reach patient populations underrepresented in mental health settings, including young men and those with poor social determinants of health. [15][16][17] To limit access for those who exhibit risk factors for suicidality, numerous states have incorporated "red flag" laws that allow family or law enforcement to confiscate firearms in certain circumstances. A study by Swanson et al 18 determined there was at least a modest deterrence rate.…”

Section: Discussionmentioning

confidence: 99%

An Ounce of Prevention is the Only Cure: Nationwide Clinical and Financial Outcomes of Self-Inflicted Firearm Injuries

Tran

Bonnick

Byun

et al. 2023

The American Surgeon™

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Background Self-inflicted gunshot wounds (SIGSWs) remain a leading, preventable cause of death in the United States. The present study evaluated patient demographics, operative characteristics, in-hospital outcomes, and resource utilization between patients with SIGSW and other GSW. Methods The 2016-2020 National Inpatient Sample was queried for patients ≥16 years old admitted following gunshot wounds. Patients were categorized as SIGSW if they were injured through self-harm. Multivariable logistic regression was used to evaluate the association of SIGSW on outcomes. The primary endpoint was in-hospital mortality with complications, costs, and length of stay secondarily considered. Results Of an estimated 157,795 surviving to hospital admission, 14,670 (9.30%) were SIGSW. Self-inflicted gunshot wounds were more commonly female (18.1 vs 11.3%), insured by Medicare (21.1 vs 5.0%), and white (70.8 vs 22.3%) (all P < .001) compared to non-SIGSW. Psychiatric illness was more prevalent in SIGSW (46.0 vs 6.6%, P < .001). Additionally, SIGSW more frequently underwent neurologic (10.7 vs 2.9%) and facial operations (12.5 vs 3.2%) (both P < .001). After adjustment, SIGSW was associated with greater odds of mortality (AOR: 12.4, 95% CI: 10.4-14.7). Length of stay (β: +1.5 days, 95% CI: .8-2.1) and costs (β: +$3.6 K, 95% CI: 1.4-5.7) were significantly greater in SIGSW. Conclusions Self-inflicted gunshot wounds are associated with increased mortality compared to other GSW, likely due to the increased proportion of injuries in the head and neck region. This lethality, coupled with the high prevalence of psychiatric illness in this population, indicates that efforts must be made to intervene through primary prevention, including enhanced screening and weapon safety considerations for those at risk.

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“…There are substantially more subtle indicators that the information shared by the client represents only a partial truth or a fabrication. It may be that the client says that they were "only joking" or contend that they were misunderstood, and that other people were overreacting to a transient expression of hopelessness (McClay et al, 2018). In the authors' experience, given the circumstances of an assessment and the motivators for concealment, these statements are frequently deflections.…”

Section: Recommendation 4: Attend To Indications Of Minimization Of Suicidalitymentioning

confidence: 97%

Addressing Concealed Suicidality: A Flexible and Contextual Approach to Suicide Risk Assessment in Adults

Nagdimon

McGovern

Craw

2021

J Contemp Psychother

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Concealed suicidality can be a major impediment for clinicians conducting a suicide risk assessment. Client minimization and denial of suicidal thoughts can lead clinicians to undertreat and under-monitor clients experiencing a suicidal crisis. Five recommendations are given to address potential weak areas of suicide assessment with adults including routinized processes and a reliance on assessment instruments that may underestimate risk when individuals have no prior attempts or significant mental illness. Specifically, the authors highlight the importance of continued training and education in suicide assessment, how considering the context of the assessment can heighten one's sensitivity to concealment of suicidal ideation and how different assessment instruments and interview techniques, when chosen with care, can increase the candor of client expression. The authors also recommend attending to clinician anxiety both as a way of maintaining rapport as well as a method of identifying clues that the assessment is not producing accurate information. Finally, application of recommendations is demonstrated through case vignettes.

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Denial of Suicide Attempt Among Hospitalized Survivors of a Self-Inflicted Gunshot Wound

Cited by 6 publications

References 22 publications

Epidemiology of Upper Extremity Firearm Injuries among Major Trauma Hospitals in the United States

Epidemiology of Upper Extremity Firearm Injuries among Major Trauma Hospitals in the United States

An Ounce of Prevention is the Only Cure: Nationwide Clinical and Financial Outcomes of Self-Inflicted Firearm Injuries

Addressing Concealed Suicidality: A Flexible and Contextual Approach to Suicide Risk Assessment in Adults

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