Patient-Reported Firearm Access Prior to Suicide Death

Richards, Julie; Boggs, Jennifer M.; Rowhani‐Rahbar, Ali; Kuo, Elena; Betz, Marian E.; Bobb, Jennifer F.; Simon, Gregory E.

doi:10.1001/jamanetworkopen.2021.42204

Cited by 7 publications

(8 citation statements)

References 5 publications

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“…Our recent retrospective cohort study found that over half the patients who died by firearm suicide during a 4-year period reported no firearm access in the year prior to death. 64 While some suicide decedents likely acquired firearms after reporting no access, others likely chose not to disclose access. 64 Third, respondents described how standard firearm access questions help normalize clinician-initiated dialogue to support patient safety and suicide prevention.…”

Section: Discussionmentioning

confidence: 99%

“… 64 While some suicide decedents likely acquired firearms after reporting no access, others likely chose not to disclose access. 64 Third, respondents described how standard firearm access questions help normalize clinician-initiated dialogue to support patient safety and suicide prevention. Several prior studies have proposed that universal firearm injury prevention counselling may be more palatable than asking patients about access.…”

Section: Discussionmentioning

confidence: 99%

“…Second, respondents described a nuanced understanding of challenges that may drive under-reporting access. Our recent retrospective cohort study found that over half the patients who died by firearm suicide during a 4-year period reported no firearm access in the year prior to death . While some suicide decedents likely acquired firearms after reporting no access, others likely chose not to disclose access .…”

Section: Discussionmentioning

confidence: 99%

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Patient and Clinician Perspectives of a Standardized Question About Firearm Access to Support Suicide Prevention

et al. 2022

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ImportanceUS residents report broad access to firearms, which are the most common means of suicide death in the US. Standardized firearm access questions during routine health care encounters are uncommon despite potential benefits for suicide prevention.ObjectiveTo explore patient and clinician experiences with a standard question about firearm access on a self-administered mental health questionnaire routinely used prior to primary care and mental health specialty encounters.Design, Setting, and ParticipantsQualitative semistructured interviews were conducted from November 18, 2019, to October 8, 2020, at Kaiser Permanente Washington, a large integrated care delivery system and insurance provider. Electronic health record data identified adult patients with a documented mental health diagnosis who had received a standard question about firearm access (“Do you have access to guns? yes/no”) within the prior 2 weeks. A stratified sampling distribution selected 30% who answered “yes,” 30% who answered “no,” and 40% who left the question blank. Two groups of clinicians responsible for safety planning with patients at risk of suicide were also sampled: (1) licensed clinical social workers (LICSWs) in primary and urgent care settings and (2) consulting nurses (RNs).Main Outcomes and MeasuresParticipants completed semistructured telephone interviews, which were recorded and transcribed. Directive (deductive) and conventional (inductive) content analyses were used to apply knowledge from prior research and describe new information. Thematic analysis was used to organize key content, and triangulation was used to describe the intersections between patient and clinician perspectives.ResultsThirty-six patients were interviewed (of 76 sampled; mean [SD] age, 47.3 [17.9] years; 19 [53%] were male; 27 [75%] were White; 3 [8%] were Black; and 1 [3%] was Latinx or Hispanic. Sixteen participants had reported firearm access and 15 had reported thoughts of self-harm on the questionnaire used for sampling. Thirty clinicians were interviewed (of 51 sampled) (mean [SD] age, 44.3 [12.1] years; 24 [80%] were female; 18 [60%] were White; 5 [17%] were Asian or Pacific Islander; and 4 [13%] were Latinx or Hispanic) including 25 LICSWs and 5 RNs. Key organizing themes included perceived value of standardized questions about firearm access, challenges of asking and answering, and considerations for practice improvement. Clinician interview themes largely converged and/or complemented patient interviews.Conclusions and RelevanceIn this qualitative study using semistructured interviews with patients and clinicians, a standardized question about firearm access was found to encourage dialogue about firearm access. Respondents underscored the importance of nonjudgmental acknowledgment of patients’ reasons for firearm access as key to patient-centered practice improvement.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Patient and Clinician Perspectives of a Standardized Question About Firearm Access to Support Suicide Prevention

et al. 2022

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“…Suicide prevention is another area in which physicians play an important role, as access to a firearm is considered a risk factor for completing suicide. Simply asking patients about firearm ownership can help screen for persons at risk for suicide [ 44 ].…”

Section: Reviewmentioning

confidence: 99%

The Role of Plastic Surgeons in Addressing Firearm Morbidity and Mortality

Safeek¹,

Ching²,

Chim³

et al. 2023

Cureus

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Firearm injuries are now the leading cause of pediatric mortality in the United States. With the number of firearm injuries increasing at an alarming rate, the American Medical Association (AMA) declared firearm violence a public health crisis. In response to this emerging public health issue, the American College of Surgeons (ACS) developed the STOP THE BLEED training to educate laypersons on how to mitigate acute hemorrhage following gunshot wounds (GSWs) and other ballistic injuries. Stabilization of patients following GSWs is often handled by a multidisciplinary team of trauma and reconstructive surgeons. Here, we describe the history and ongoing role of reconstructive surgeons in preventing and addressing firearm morbidity and mortality. Hand surgeons are uniquely positioned to counsel patients on firearm safety, e.g., educating patients on proper firearm storage away from minors in the home, in an effort to mitigate accidental firearm injury to the upper extremity. As the evolving climate of firearm violence continues to rise, plastic and reconstructive surgeons will continue to play a critical role in restoring form and function among patients afflicted with GSWs.

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“…Many primary care patients who subsequently die by firearm suicide will honestly answer screening questions about firearm access ( 64 ). Because of the high fatality linked to firearm ownership, recent evidence suggests that screening all primary care patients for firearms ownership with appropriate follow up care may prevent death from suicide for those who do not have a mental health or SUD diagnosis.…”

Section: Screeningmentioning

confidence: 99%

Improving Suicide Prevention in Primary Care for Differing Levels of Behavioral Health Integration: A Review

et al. 2022

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ImportanceSuicide prevention implementation in primary care is needed due to the increasing rate of suicide in the past few decades, particularly for young and marginalized people. Primary care is the most likely point of contact for suicidal patients in the healthcare system. Attention to the level of medical integration with behavioral health is vital to suicide prevention and is applied throughout this review.MethodsA narrative review was performed.ObservationsMany interventions help improve suicide prevention care. PCP education, screening, safety planning/lethal means reduction, care transitions, psychotherapy, and medication management are all evidence-based strategies. Additionally, the pragmatic topics of financing suicide prevention, supporting providers, enacting suicide postvention, and preparing for future directions in the field at each level of primary care/behavioral health integration are discussed.Conclusions and RelevanceThe findings are clinically relevant for practices interested in implementing evidence-based suicide prevention strategies by attending to the behavioral health/medical interface. Leveraging the patient/provider relationship to allow for optimal suicide prevention care requires clinics to structure provider time to allow for emotionally present care. Defining clear roles for staff and giving attention to provider well being are also critical factors to supporting primary care-based suicide prevention efforts.

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Patient-Reported Firearm Access Prior to Suicide Death

Cited by 7 publications

References 5 publications

Patient and Clinician Perspectives of a Standardized Question About Firearm Access to Support Suicide Prevention

Patient and Clinician Perspectives of a Standardized Question About Firearm Access to Support Suicide Prevention

The Role of Plastic Surgeons in Addressing Firearm Morbidity and Mortality

Improving Suicide Prevention in Primary Care for Differing Levels of Behavioral Health Integration: A Review

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