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Suicide Attempt, Ideation Patients Should Be Asked About Firearms in Home

AURORA, CO – Whether emergency physicians are too busy saving lives, uncomfortable with the questions, or simply skeptical about the approach, only about half ask suicidal patients if they have access to firearms or other methods of killing themselves at home, according to new research.

National guidelines recommend that ED physicians gather that information, according to a study published recently in the journal Depression and Anxiety.

For the study, University of Colorado Anschutz Medical Campus researchers interviewed 1,358 patients who had either attempted suicide or were thinking about it and sought treatment at one of eight EDs in seven states.

"We asked the patients about their access to firearms and then reviewed their charts," recounted lead author Emmy Betz, MD, MPH. “We found in about 50% of cases there is no documentation by the doctor that anyone asked the patients about firearms access. That means there is a large group of patients we are missing a chance to intervene for."

Results indicate that about 25% of potentially suicidal patients who said they had guns at home kept at least one of them loaded and unlocked. Overall, half of the patients surveyed had convenient access to guns, putting themselves at risk for future suicide attempts.

Among a subgroup of 337 patients discharged to home, 55% had no documentation of lethal means assessment, although 13% of them had one or more firearms at home. Among all of the participants who told staff they had one or more firearms at home, only 50% had documentation of assessment of lethal means access, according to the study.

"Multiple ED visits appear to be a risk factor for suicide and many suicide victims are seen in the ED shortly before death," study authors write. "Based on models using national suicide statistics, ED-based interventions might help decrease suicide deaths by 20% annually."

The article cites previous studies suggesting, however, that ED doctors are skeptical about the effectiveness of that type of intervention.

"This rate of assessment falls short of national guidelines recommending that all suicidal patients receive counseling about reducing access to firearms and other lethal means," Betz said in a University of Colorado Anschutz Medical Campus press release. "Lethal means assessment is important for both overall risk assessment and for safety planning for patients being discharged."

Betz suggested that ED staff involve patient families, asking them to lock up firearms or remove them from the house.

"It is legal and appropriate to ask about this when it is relevant as it is in the case of suicide attempts or suicidal ideation," Betz said. "Do it in a respectful, non-judgmental way and it will usually be well-received. Still, there isn't a lot of training on this. As a result, we are missing the chance to save a lot of lives."