Prevention of elderly suicide. Physicians' assessment of firearm availability.

INTRODUCTION: Physicians have a unique role to play in the prevention of elder suicide, yet they may not be sufficiently attentive to the prominence of firearms in the rising trend in suicide by elder persons. This study sought to examine the extent to which physicians inquired about firearms with their depressed and suicidal elderly patients and further identified factors associated with physicians' likelihood of asking about firearms.
METHODS: A probability sample of 300 primary care physicians in Illinois was drawn from the American Medical Association Physician Masterfile. Physicians were chosen from the specialties most likely to be involved with elderly persons: internal medicine and family practice. A mailed questionnaire yielded a 63% response rate.
RESULTS: Although they were treating depressed and suicidal older patients, a sizable proportion of the respondents (42%) reported that they did not ask such patients or their family members whether they had access to a firearm. Several factors distinguished physicians who assessed for firearms from those who did not. The most salient predictors were: continuing medical education training in suicide risk assessment, expertise in geriatric mental health, confidence in diagnosing depression, having a patient mention suicide in the past year, and indicating patient reluctance as a barrier to mental health treatment. DISCUSSION: Physicians working with depressed and suicidal elderly persons need to be informed about the prevalence of elder suicide and about the likelihood of elderly persons using firearms as a method of suicide. Effective suicide prevention will require physician training that directly addresses geriatric mental health and firearm suicide, in particular, at the student, residency, and continuing education levels.