Marian E Betz1, Matthew Miller2, Catherine Barber2, Brenda Beaty3, Ivan Miller4, Carlos A Camargo5, Edwin D Boudreaux6. 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.
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.
Authors: Marian E Betz; Sarah A Arias; Matthew Miller; Catherine Barber; Janice A Espinola; Ashley F Sullivan; Anne P Manton; Ivan Miller; Carlos A Camargo; Edwin D Boudreaux Journal: Psychiatr Serv Date: 2015-03-01 Impact factor: 3.084
Authors: M J Kruesi; J Grossman; J M Pennington; P J Woodward; D Duda; J G Hirsch Journal: J Am Acad Child Adolesc Psychiatry Date: 1999-03 Impact factor: 8.829
Authors: Marian E Betz; Matthew Miller; Catherine Barber; Ivan Miller; Ashley F Sullivan; Carlos A Camargo; Edwin D Boudreaux Journal: Depress Anxiety Date: 2013-03-14 Impact factor: 6.505
Authors: Edwin D Boudreaux; Ivan Miller; Amy B Goldstein; Ashley F Sullivan; Michael H Allen; Anne P Manton; Sarah A Arias; Carlos A Camargo Journal: Contemp Clin Trials Date: 2013-05-22 Impact factor: 2.226
Authors: Sofiya Diurba; Rachel L Johnson; Bonnie J Siry; Christopher E Knoepke; Krithika Suresh; Scott A Simpson; Deborah Azrael; Megan L Ranney; Garen J Wintemute; Marian E Betz Journal: Suicide Life Threat Behav Date: 2020-06-29
Authors: Megan L Ranney; Jonathan Fletcher; Harrison Alter; Christopher Barsotti; Vikhyat S Bebarta; Marian E Betz; Patrick M Carter; Magdalena Cerdá; Rebecca M Cunningham; Peter Crane; Jahan Fahimi; Matthew J Miller; Ali Rowhani-Rahbar; Jody A Vogel; Garen J Wintemute; Muhammad Waseem; Manish N Shah Journal: Ann Emerg Med Date: 2016-12-18 Impact factor: 5.721
Authors: Marian E Betz; Mack Kautzman; Daniel L Segal; Ivan Miller; Carlos A Camargo; Edwin D Boudreaux; Sarah A Arias Journal: Psychiatry Res Date: 2017-11-14 Impact factor: 3.222
Authors: Marian E Betz; Christopher E Knoepke; Bonnie Siry; Ashley Clement; Deborah Azrael; Stephanie Ernestus; Daniel D Matlock Journal: Inj Prev Date: 2018-10-13 Impact factor: 2.399
Authors: Marian E Betz; Ashley Brooks-Russell; Sara Brandspigel; Douglas K Novins; Gregory J Tung; Carol Runyan Journal: J Emerg Nurs Date: 2018-04-25 Impact factor: 1.836
Authors: Carol W Runyan; Ashley Brooks-Russell; Gregory Tung; Sara Brandspigel; Marian E Betz; Douglas K Novins; Robert Agans Journal: Am J Prev Med Date: 2017-12-14 Impact factor: 5.043