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Suicidal patients in ED often not asked about firearms

Wednesday April 3, 2013
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Many ED physicians and nurses do not routinely ask suicidal patients about their access to firearms, according to a study.

“In our study, less than half of emergency room medical providers believe most or all suicides are preventable, and many rarely ask about the availability of firearms,” Marian Betz, MD, MPH, the study’s lead author and an assistant professor of emergency medicine at the University of Colorado School of Medicine, said in a news release. “There is a great opportunity to save lives here that many are not taking advantage of.”

For the study, which was published March 14 on the website of the journal Depression and Anxiety, researchers surveyed 631 ED physicians and nurses in eight American hospitals as part of the Emergency Department Safety Assessment and Follow-up Evaluation trial.

They found that 44% of physicians and 67% of nurses believed that most or all of those who committed suicide with a gun would have found another way if the firearm was not available.

They also found that 49% of physicians and 72% of nurses said they “hardly ever” personally counsel patients or families to remove or lock up guns at home.

Of providers who said they “almost always” asked suicidal patients about their access to firearms, the proportion varied according to the scenario: 64% would almost always ask in the event the patient had an actual plan to commit suicide with a gun; 22% would ask in the event the patient was suicidal but had no suicide plan; 21% would ask in the event the patient was suicidal with a non-firearm plan; 16% would ask in the event the patient had been suicidal in the past month, but was not at the time; 9% would ask in the event the patient had overdosed but no longer was suicidal.

In 2010, 38,000 people committed suicide in the U.S. and another 465,000 were treated in the ED for self-inflicted injuries as the result of a suicide attempt, according to the study. In the year before they died, 40% of people who committed suicide visited an ED at least once, and often in many cases.

“This is an opportunity for intervention, but very often providers don’t know how to react or they think someone else should ask about firearms,” Betz said. “And then some have an aversion to getting into an area so fraught with politics. This is not an issue of gun control; it’s a safety issue for patients in crisis.”

In the study, most felt it was the responsibility of psychiatrists, psychiatric nurses or social workers to ask about firearms.

“If a suicidal person has a gun you could come up with a plan to put it in a safe place,” Betz said. “Sometimes, the police or a family member can take it. Or it can be locked up in a safe.”

The study acknowledged the growing caseloads in EDs and the difficulty in conducting lengthy counseling sessions of suicidal patients. The best option, Betz said, would be for EDs to have mental health professionals standing by.

“However, brief risk assessment of access to lethal means and possibly brief interventions are reasonable skills for emergency department providers to master,” she said, noting these skills should be incorporated into medical education.

“Whenever we have the opportunity to save a life, we ought to be taking it.”

The study abstract is available at http://onlinelibrary.wiley.com/doi/10.1002/da.22075/abstract.


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