Clinical strategies for reducing firearm suicide

Abstract

Suicide is complex, with psychiatric, cultural, and socioeconomic roots. Though mental illnesses like depression contribute to risk for suicide, access to lethal means such as firearms is considered a key risk factor for suicide, and half of suicides in the USA are by firearm. When a person at risk of suicide has access to firearms, clinicians have a range of options for intervention. Depending on the patient, the situation, and the access to firearms, counseling on storage practices, temporary transfer of firearms, or further intervention may be appropriate. In the USA, ownership of and access to firearms are common and discussing added risk of access to firearms for those at risk of suicide is not universally practiced. Given the burden of suicide (particularly by firearm) in the USA, the prevalence of firearm access, and the lethality of suicide attempts with firearms, we present the existing evidence on the burden of firearm suicide and what clinicians can do to reduce their patients’ risk. Specifically, we review firearm ownership in the USA, firearm injury epidemiology, risk factors for firearm-related harm, and available interventions to reduce patients’ risk of firearm injury and death.

Trends in Adolescent Suicide by Method in the US, 1999-2020

“…This finding is attributed to the higher likelihood of male adolescents residing in gun-owning homes and carrying guns, which are factors strongly associated with suicide risk and mortality . Notably, although firearm suicide mortality rates appeared to decrease from 1999 to 2007—a trend shown previously—we observed a sharp increase in firearm suicide among both female and male adolescents from 2007 to 2020, which may reflect the surge in new gun owners and youth exposure to gun violence . Additionally, unsafe gun-storing practices persist as a significant nationwide problem and can prove fatal.…”

Firearms, Suicide, and Approaches for Prevention

“…Lethal means safety (LMS)-in which access to firearms and other lethal methods is reduced-is an evidencebased approach to reducing suicide risk. 5 For firearms, this means removing firearms from the home or changing home storage so the individual with suicide risk does not have access to these weapons. Ideally, such reductions are voluntary and engage the at-risk person in short-term changes, which allows for the individual at risk to take ownership of their own health while still reducing risk.…”

“…In clinical settings, LMS is an essential element of evidence-based suicide prevention programs because (1) clinicians are already charged with assessing and mitigating suicide risk across varied patient populations and settings; (2) an estimated 80% of individuals who die by suicideengagewiththehealthcaresystemintheyearprior to death 6 ; and (3) clinician-delivered interventions are effective in motivating secure firearm storage practices. 5 In recent years, LMS training and resources for clinicians across a variety of clinical specialties have expanded, including consensus statements on clinician education, system initiatives like in the Veterans Health Administration, and state-funded training programs like the BulletPoints Project in California.…”

“…Lethal means safety (LMS)—in which access to firearms and other lethal methods is reduced—is an evidence-based approach to reducing suicide risk . For firearms, this means removing firearms from the home or changing home storage so the individual with suicide risk does not have access to these weapons.…”

“…In clinical settings, LMS is an essential element of evidence-based suicide prevention programs because (1) clinicians are already charged with assessing and mitigating suicide risk across varied patient populations and settings; (2) an estimated 80% of individuals who die by suicide engage with the health care system in the year prior to death; and (3) clinician-delivered interventions are effective in motivating secure firearm storage practices …”