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Half of Suicidal ER Patients Aren't Asked About Access to Guns

A new survey finds a whole lot of missed chances in American emergency departments.

by Michael Byrne
Mar 21 2016, 12:30pm

Image: Hakat/Shutterstock

Only about half of suicidal patients that wind up in American emergency rooms are asked about their access to firearms, despite national guidelines urging them to do so, and, well, the general obviousness of the question. This is according to a study published Sunday in the journal Depression and Anxiety by researchers at the University of Colorado School of Medicine.

To reach this conclusion, the study authors polled some 1,358 patients from eight different emergency departments in seven states. The patients were asked about their access to firearms and then the researchers reviewed their charts. In 50 percent of cases, there was no documentation to indicate that ER docs or anyone else had asked about firearm access—a task known as "lethal means assessment."

Of the patients polled, about 11 percent actually had access to firearms, while a quarter of those reported having a loaded and unlocked firearm.

Emergency departments are recognized as a crucial suicide safety net. As noted in the current study, around 8 percent of ED admissions involve suicide attempts and suicide ideation. "Multiple ED visits appear to be a risk factor for suicide and many suicide victims are seen in the ED shortly before death," the study explains. "Based on models using national suicide statistics, ED-based interventions might help decrease suicide deaths by 20 percent annually."

"Based on models using national suicide statistics, ED-based interventions might help decrease suicide deaths by 20 percent annually."

The obvious question is then why? Why aren't emergency department docs asking the people most in danger from guns about their access to guns?

A 2013 study, also from the University of Colorado. offered some insight into the question, surveying 631 ED physicians and nurses about their interactions with suicidal patients. It found that less than half of ED personnel believed that suicide is preventable in the first place. Moreover, 44 percent of doctors and 67 percent of nurses thought that most or all of patients that commit suicide with a firearm would find another way to kill themselves sans firearm.

These attitudes are wrong. Largely, this wrongness has to do with the brevity of suicidal episodes. Suicide is an impulse that passes quickly, and throwing up barriers that may seem on the outside to be symbolic or ineffectual are often all it takes to stop someone from taking their own life. This is why guns, in particular, are such a concern. Suicide by bullet is quick and assured. As the current study authors note, 90 percent of suicide attempts by gun are successful, vs. 2 percent for medication overdoses.

"It is legal and appropriate to ask about this when it is relevant as it is in the case of suicide attempts or suicidal ideation," offers lead author Emma Betz in a statement. "Do it in a respectful, non-judgmental way and it will usually be well-received. Still, there isn't a lot of training on this. As a result, we are missing the chance to save a lot of lives."