“What Will Happen If I Say Yes?” Perspectives on a Standardized Firearm Access Question Among Adults With Depressive Symptoms

Richards, Julie; Hohl, Sarah D.; Segal, Courtney; Grossman, David C.; Lightner, Amy L.; Whiteside, Ursula; Luce, Casey; Ludman, Evette; Simon, Greg; Penfold, Robert B.; Williams, Emily C.

doi:10.1176/appi.ps.202000187

Cited by 20 publications

(39 citation statements)

References 57 publications

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“…This finding extends prior population-based survey research indicating that most patients believe that questions about firearm access are appropriate for suicide prevention 40 and qualitative research describing how adult patients perceived a standard question about firearm access as being relevant to their MH care. 41 The rates and correlates of reported firearm access in this large health care system population are also consistent with prior research in Washington State 25 , 42 , 43 , 44 demonstrating higher rates of firearm access among men and adult respondents who were older, White, living in rural areas, and reporting higher levels of alcohol consumption. Findings are also consistent with survey-based studies among adult clinical populations reporting lower rates of firearm access among those also reporting prior suicide attempts 45 , 46 or suicidal thoughts.…”

Section: Discussionsupporting

confidence: 83%

“… 61 , 62 Finally, concerns about privacy, surveillance, or Extreme Risk Protection Orders (“red flag” laws) in many states (including Washington) 63 , 64 may affect how patients perceive and answer firearm questions (ie, reported access may not reflect “true state”). 41 Though response rates were high in PC and MH settings, nonresponse rates were higher to this question than to all the other questions, which supports prior qualitative findings indicating that practices designed to clarify the purpose and use of firearm access may encourage firearm access disclosures and facilitate dialogue about safe storage. 41 …”

Section: Discussionsupporting

confidence: 73%

“… 41 Though response rates were high in PC and MH settings, nonresponse rates were higher to this question than to all the other questions, which supports prior qualitative findings indicating that practices designed to clarify the purpose and use of firearm access may encourage firearm access disclosures and facilitate dialogue about safe storage. 41 …”

Section: Discussionsupporting

confidence: 73%

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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: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 73%

Section: Discussionsupporting

confidence: 73%

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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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“…While primary care screening for firearm ownership and safety has been widely advocated, 33 such screening may pose particular challenges in relation to mental health. For example, a qualitative study of 37 individuals with depression identified a range of concerns related to firearm screening 34 —in particular, participant wariness about the response that admitting to firearm ownership might elicit. These challenges suggest that more narrowly directed or stratified strategies may be valuable, particularly in the context of depression or suicidality.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Firearm Ownership Among Individuals With Major Depressive Symptoms

et al. 2022

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Key Points Question How common is firearm ownership, a risk factor for suicide, among individuals with major depressive symptoms in the United States? Findings In this cross-sectional survey study including 24 770 respondents, individuals with moderate depressive symptoms were as likely as those without to own firearms but more likely to have recently purchased a first firearm and to express interest in a purchase in the near future. Meaning The findings of this study suggest that firearm ownership is common among individuals with depression in the United States, highlighting an opportunity to diminish suicide risk through focused interventions.

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“…Nevertheless, prior qualitative findings suggest that transparency about how firearm access information will be used and building clinician competency and clinician–patient trust may encourage honest reporting, open dialogue, and improved patient-centeredness of this practice. 6 Assessing patients’ plans to acquire firearms may also be useful. Future work is needed to test language and strategies designed to encourage patient-reported firearm access.…”

Section: Discussionmentioning

confidence: 99%

Patient-Reported Firearm Access Prior to Suicide Death

et al. 2022

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“What Will Happen If I Say Yes?” Perspectives on a Standardized Firearm Access Question Among Adults With Depressive Symptoms

Cited by 20 publications

References 57 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

Prevalence of Firearm Ownership Among Individuals With Major Depressive Symptoms

Patient-Reported Firearm Access Prior to Suicide Death

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