SEATTLE — When patients receiving care for mental health were asked to complete a standardized questionnaire that included the question, “Do you have access to guns?” most provided a response, according to a Kaiser Permanente study published in JAMA Health Forum.
Firearms are the most common — and most lethal — method of suicide in the United States. Routinely asking patients about firearm access could support suicide prevention by creating opportunities to discuss safety planning, including appropriate storage of firearms and ammunition.
"Asking about the availability of firearms could help clinicians start conversations about safely storing them when patients are at risk of suicide," said lead study author Julie Richards, PhD, MPH, research associate at Kaiser Permanente Washington Health Research Institute. "Our study helps dispel concerns by clinicians and health system leaders that patients won't respond to firearm questions."
Beginning in August 2015, Kaiser Permanente Washington added a question about firearm access to a standard questionnaire given to all patients during visits to outpatient mental health clinics. Subsequently, Kaiser Permanente integrated some mental health services into primary care and began giving the questionnaire at primary care visits to patients over age 18 who had a depression or substance use disorder diagnosis. Patient responses are documented in the electronic health record to help guide appropriate follow-up care.
A Kaiser Permanente Washington research team conducted a cross-sectional analysis of questionnaires completed on paper during 488,488 in-person primary care or mental health clinic visits by 128,802 patients from January 1, 2016, through December 13, 2019. The team looked at the proportion of patients who answered the question about firearm access and the proportion who reported having access to a firearm. Additional data from the electronic health record system and other sources included sociodemographic information associated with firearm ownership and suicide risk such as age, sex, race and ethnicity, and rural or urban residence.
In primary care, 83% of patients answered the firearm access question, with 21% reporting access. In mental health clinics, 92% of patients answered the question, with 15% reporting access. There were small differences in the characteristics of patients who answered and those who didn’t but larger differences among patients who reported access versus no access. Men were more likely to report access than women, as were people living in rural and suburban areas than people in urban areas. Those who had a prior-year suicide attempt had the lowest rates of firearms access.
"Questions about firearm access during primary care and mental health visits have a lot of potential value in suicide prevention," said Dr. Richards. "When we don’t ask these questions, we reinforce the notion that we shouldn’t talk to our patients about firearms. Change is hard, but normalizing the practice of asking about firearm access could save lives.”
A study published in May 2021 from the research team found that patients may choose to not disclose firearm access due to concerns about privacy, stigma, and firearm removal. Study results suggested that clarifying the purpose and use of the firearm access question may encourage openness and dialogue about safe storage. The research team, which includes people with lived experience of suicidality, is working on clinical practices that support nonjudgmental conversations about firearm access and suicide risk.
This study was funded by Kaiser Permanente’s Office of Community Health as part of its Firearm Injury Prevention Program.
In addition to Dr. Richards, study authors are Elena Kuo, PhD, MPH, Christine Stewart, PhD, Jennifer F. Bobb, PhD, Kayne D. Mettert, Rebecca Parrish, LICSW, and Gregory E. Simon, MD, MPH, from Kaiser Permanente Washington; Ali Rowhani-Rahbar, MD, MPH, PhD, from the University of Washington; Marian E. Betz, MD, MPH, from the University of Colorado; Ursula Whiteside, PhD, from NowMattersNow; and Jennifer M. Boggs, PhD, MSW, from Kaiser Permanente Colorado.
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