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Depress Anxiety. 2016 Jun;33(6):502-11. doi: 10.1002/da.22486. Epub 2016 Mar 17.

LETHAL MEANS ACCESS AND ASSESSMENT AMONG SUICIDAL EMERGENCY DEPARTMENT PATIENTS.

Author information

1
Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado.
2
Harvard Injury Control Research Center, Harvard School of Public Health, Boston, Massachusetts.
3
Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
4
Butler Hospital, Providence, Rhode Island.
5
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
6
Departments of Emergency Medicine, Psychiatry, and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.

Abstract

BACKGROUND:

Reducing access to lethal means (especially firearms) might prevent suicide, but counseling of at-risk individuals about this strategy may not be routine. Among emergency department (ED) patients with suicidal ideation or attempts (SI/SA), we sought to describe home firearm access and examine ED provider assessment of access to lethal means.

METHODS:

This secondary analysis used data from the Emergency Department Safety Assessment and Follow-up Evaluation, a three-phase, eight-center study of adult ED patients with SI/SA (2010-2013). Research staff surveyed participants about suicide-related factors (including home firearms) and later reviewed the ED chart (including documented assessment of lethal means access).

RESULTS:

Among 1,358 patients with SI/SA, 11% (95% CI: 10-13%) reported ≥1 firearm at home; rates varied across sites (range: 6-26%) but not over time. On chart review, 50% (95% CI: 47-52%) of patients had documentation of lethal means access assessment. Frequency of documented assessment increased over study phases (40-60%, P < .001) but was not associated with state firearm ownership rates. Among the 337 (25%, 95% CI: 23-27%) patients discharged to home, 55% (95% CI: 49-60%) had no documentation of lethal means assessment; of these, 13% (95% CI: 8-19%; n = 24) actually had ≥1 firearm at home. Among all those reporting ≥1 home firearm to study staff, only half (50%, 95% CI: 42-59%) had provider documentation of assessment of lethal means access.

CONCLUSIONS:

Among these ED patients with SI/SA, many did not have documented assessment of home access to lethal means, including patients who were discharged home and had ≥1 firearm at home.

KEYWORDS:

assessment/diagnosis; clinical trials; depression; epidemiology; suicide/self-harm; treatment

PMID:
26989850
PMCID:
PMC4800489
DOI:
10.1002/da.22486
[Indexed for MEDLINE]
Free PMC Article

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