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LETHAL MEANS RESTRICTION FOR SUICIDE PREVENTION: BELIEFS AND BEHAVIORS OF EMERGENCY DEPARTMENT PROVIDERS

Authors

  • Marian E. Betz M.D., M.P.H.,

    Corresponding author
    • Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado
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  • Matthew Miller M.D., M.P.H., Sc.D.,

    1. Department of Health Policy and Management, Harvard Injury Control Research Center, Harvard School of Public Health, Boston, Massachusetts
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  • Catherine Barber M.P.A.,

    1. Department of Health Policy and Management, Harvard Injury Control Research Center, Harvard School of Public Health, Boston, Massachusetts
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  • Ivan Miller Ph.D.,

    1. Department of Psychiatry and Human Behavior, Brown University and Butler Hospital, Providence, Rhode Island
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  • Ashley F. Sullivan M.S., M.P.H.,

    1. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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  • Carlos A. Camargo Jr. M.D., Dr.P.H.,

    1. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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  • Edwin D. Boudreaux Ph.D.,

    1. Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
    2. Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
    3. Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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  • on behalf of the ED-SAFE Investigators


  • This work was orally presented at the 2012 American Public Health Association Annual Meeting (October 2012).

  • Contract grant sponsor: National Institute of Mental Health; Contract grant number: U01MH088278; Contract grant sponsor: American Foundation for Suicide Prevention; Contract grant sponsor: Joyce and Bohnett Foundations.

Correspondence to: Dr. Marian Betz, Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue B-215, Aurora, CO 80045. E-mail: marian.betz@ucdenver.edu

Abstract

Background

We sought to examine the beliefs and behaviors of emergency department (ED) providers related to preventing suicide by reducing suicidal patients’ access to lethal methods (means restriction) and identify characteristics associated with asking patients about firearm access.

Methods

Physicians and nurses at eight EDs completed a confidential, voluntary survey.

Results

The response rate was 79% (n = 631); 57% of respondents were females and 49% were nurses. Less than half believed, “most” or “all” suicides are preventable. More nurses (67%) than physicians (44%) thought “most” or “all” firearm suicide decedents would have died by another method had a firearm been unavailable (P < .001). The proportion of providers who reported they “almost always” ask suicidal patients about firearm access varied across five patient scenarios: suicidal with firearm suicide plan (64%), suicidal with no suicide plan (22%), suicidal with nonfirearm plan (21%), suicidal in past month but not today (16%), and overdosed but no longer suicidal (9%). In multivariable logistic regression, physicians were more likely than nurses to “almost always” or “often” ask about a firearm across all five scenarios, as were older providers and those who believed their own provider type was responsible for assessing firearm access.

Conclusions

Many ED providers are skeptical about the preventability of suicide and the effectiveness of means restriction, and most do not assess suicidal patients’ firearm access except when a patient has a firearm suicide plan. These findings suggest the need for targeted staff education concerning means restriction for suicide prevention.

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