Frequency of Clinicians’ Assessments for Access to Lethal Means in Persons at Risk for Suicide

Boggs, Jennifer M.; Quintana, LeeAnn M.; Powers, Julia; Hochberg, S.; Beck, Arne

doi:10.1080/13811118.2020.1761917

Cited by 20 publications

(11 citation statements)

References 21 publications

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“…Asking patients to routinely self-report firearm access can help clinicians identify and engage patients at risk of suicide in dialogue regarding storage of firearms and/or ammunition (ie, increasing time and/or distance required to access firearms), which is a recommended component of evidence-based safety planning interventions for suicide prevention. 14 , 17 , 18 Yet the quality of the safety planning practices is variable, 15 , 49 , 50 and using information reported in response to standard questions about firearm access, instead of relying on clinicians to decide whether to ask patients, may help improve this practice. However, despite potential benefits, national debate remains as to whether and how health care organizations should collect and store firearm access information.…”

Section: Discussionmentioning

confidence: 99%

“…In PC, 20.9% of patients who responded to the firearm question reported having access; in MH, 15.3% of patients reported having access. Most sociodemographic and clinical characteristics were statistically associated with reporting firearm access, but the magnitude of differences was largest (±10%) for sex, rural/urban residence, and prior-year suicide attempt diagnosis ( in MH, and the magnitude of the differences was largest (±10%) for rural/urban residence and prior-year suicide attempt diagnosis (Table 3).…”

Section: Firearm Access Reportedmentioning

confidence: 99%

“…One study found that only one-third of patients reporting suicidal thoughts in the prior 2 weeks were assessed for firearm access, 14 and another reported similar rates, even among patients with recent emergency care visits for suicidality. 15 Implementing standardized firearm access questions can likely increase firearm access identification; for example, a retrospective medical record review of hospitalized psychiatric patients found that reporting access to firearms increased from 1% to 9% after implementing routine firearm screening. 16 Because using standard questions to routinely assess firearm access among adult patients is rare, we have limited knowledge as to whether and how patients might answer standard population-based firearm access questions.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Self-reported Access to Firearms Among Patients Receiving Care for Mental Health and Substance Use

et al. 2021

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IMPORTANCE Firearms are the most common method of suicide, one of the "diseases of despair" driving increased mortality in the US over the past decade. However, routine standardized questions about firearm access are uncommon, particularly among adult populations, who are more often asked at the discretion of health care clinicians. Because standard questions are rare, patterns of patient-reported access are unknown. OBJECTIVE To evaluate whether and how patients self-report firearm access information on a routine mental health monitoring questionnaire and additionally to examine sociodemographic and clinical associations of reported access. DESIGN, SETTING, AND PARTICIPANTSCross-sectional study of patients receiving care for mental health and/or substance use in primary care or outpatient mental health specialty clinics of Kaiser Permanente Washington, an integrated health insurance provider and care delivery system. MAIN OUTCOMES AND MEASURESElectronic health records were used to identify patients who completed a standardized self-reported mental health monitoring questionnaire after a single question about firearm access was added from January 1, 2016, through December 31, 2019. Primary analyses evaluated response (answered vs not answered) and reported access (yes vs no) among those who answered, separately for patients seen in primary care and mental health. These analyses also evaluated associations between patient characteristics and reported firearm access. Data analysis took place from February 2020 through May 2021.RESULTS Among patients (n = 128 802) who completed a mental health monitoring questionnaire during the study period, 74.4% (n = 95 875) saw a primary care clinician and 39.3% (n = 50 631) saw a mental health specialty clinician. The primary care and mental health samples were predominantly female (63.1% and 64.9%, respectively) and White (75.7% and 77.0%), with a mean age of 42.8 and 51.1 years. In primary care, 83.4% of patients answered the question about firearm access, and 20.9% of patients who responded to the firearm question reported having access. In mental health, 91.8% of patients answered the question, and 15.3% reported having access. CONCLUSIONS AND RELEVANCEIn this cross-sectional study of adult patients receiving care for mental health and substance use, most patients answered a question about firearm access on a standardized mental health questionnaire. These findings provide a critical foundation to help advance understanding of the utility of standardized firearm access assessment and to inform development of practice guidelines and recommendations. Responses to standard firearm access questions used in combination with dialogue and decision-making resources about firearm access and storage may improve suicide prevention practices and outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Firearm Access Reportedmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Self-reported Access to Firearms Among Patients Receiving Care for Mental Health and Substance Use

et al. 2021

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“…As one aspect of this effort, we gathered preliminary qualitative data (reported here) from patients to learn to what extent the education program may have impacted staff-patient interactions following depression and PTSD screening. Based on our and others' work showing low rates of documentation of firearms discussions in clinical records, even among patients with known elevated suicide risk, [27][28][29][30] we expected that despite staff participation in the training program, many patients would not have had firearms safety discussions with their clinicians. We therefore also sought to gather patient perspectives on the idea of discussing firearms safety with primary care staff even when they had not had such discussions.…”

Section: Methodsmentioning

confidence: 99%

Veterans Are Agreeable to Discussions About Firearms Safety in Primary Care

et al. 2021

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Background: Discussing safe storage of firearms, including access, during times of crisis with veterans in primary care settings may enhance suicide prevention efforts. However, veteran attitudes toward such discussions are not well understood. The goal of this study is to understand the perspectives of veterans on discussing firearms storage safety with staff during primary care visits.Methods: Individual semistructured interviews with veterans were conducted by telephone, qualitatively coded, and analyzed for themes. The sample was composed of veterans (n = 27) who had positive depression or post-traumatic stress disorder screens and who received care from Veterans Health Administration primary care team members trained to discuss firearms storage safety with patients.Results: Citing the urgent need to prevent veteran suicide, most veterans felt discussing firearms safety was acceptable and needed, even if discussions felt uncomfortable or they had concerns. Veterans identified the need for providers to be transparent in their purposes for asking about firearms and to respect veterans' unique relationships with firearms.Discussion: Conducting firearms safety discussions in a primary care setting with veterans who are at elevated risk for suicide is acceptable to veterans when a respectful, veteran-centered, and transparent approach is used.

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A Randomized Control Trial of a Digital Health Tool for Safer Firearm and Medication Storage for Patients with Suicide Risk

Boggs,

Quintana,

Beck

et al. 2024

Prev Sci

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Frequency of Clinicians’ Assessments for Access to Lethal Means in Persons at Risk for Suicide

Cited by 20 publications

References 21 publications

Self-reported Access to Firearms Among Patients Receiving Care for Mental Health and Substance Use

Self-reported Access to Firearms Among Patients Receiving Care for Mental Health and Substance Use

Veterans Are Agreeable to Discussions About Firearms Safety in Primary Care

A Randomized Control Trial of a Digital Health Tool for Safer Firearm and Medication Storage for Patients with Suicide Risk

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