Disclosures: One study author reports receiving grants from Kaiser Permanente’s Office of Community Health during the conduct of the study. The other authors report no relevant financial disclosures.
January 10, 2022
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Firearm access screening may mitigate suicide risk

Disclosures: One study author reports receiving grants from Kaiser Permanente’s Office of Community Health during the conduct of the study. The other authors report no relevant financial disclosures.
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A questionnaire with a standardized firearm access question may help identify suicide risk, according to results of a population-based case series published in JAMA Network Open.

“No national practice recommendations exist for implementing standardized firearm access screening,” Julie E. Richards, PhD, MPH, of Kaiser Permanente Washington Heath Research Institute in Seattle, and colleagues wrote. “Health care systems more commonly rely on clinicians to ask patients about firearm access and ownership at their discretion. In 2015, Kaiser Permanente Washington added the question, ‘Do you have access to guns? (yes/no),’ to a standard mental health monitoring questionnaire to support suicide risk identification and safety planning.”

gun on table
Source: Adobe Stock

In the current study, the investigators aimed to examine responses to this question by individuals who died by suicide who received outpatient care within the year before death by suicide. They defined cause-of-death indicators for firearm vs. other suicide means via ICD-10 codes for intentional self-harm by firearm. Further, they extracted sociodemographic and clinical characteristics from electronic health data.

Results showed 236 ambulatory care patients died by suicide during the observation period. A total of 114 (48%) died by firearm, of whom 104 (91%) had utilized care in at least one clinic that used the mental health questionnaire, with 82% at a primary care clinic, 26% at a mental health specialty care clinic and 36% at urgent care. Among this subset, 67 (59%) had mental health or substance use disorder diagnoses, 41 (36%) received the firearm question, 38 (33%) answered and 17 (15%) reported access. A total of 84 of 122 other individuals who died by suicide (69%) had mental health or substance use disorder diagnoses, 51 (42%) received the firearm question, 44 (36%) answered and two (2%) reported access.

“Our findings have important implications for health care systems that are considering firearm access screening to support suicide prevention,” Richards and colleagues wrote. “First, this study underscored the potential reach of standardized firearm access questions in primary care clinics, which implemented routine use of this question during the study and where the highest proportion of firearm suicide decedents were seen prior to death. Second, the decision to only ask primary care patients with a [mental health] or [substance use disorder] diagnosis about firearm access likely resulted in missed opportunities, as many firearm suicide decedents did not have these diagnoses.”