Psychiatrists' practices and perceptions regarding anticipatory guidance on firearms

Background: Most suicides (60%) and homicides (67%) are committed with firearms. Additionally, 90% of homicide offenders and 80% of persons reporting suicide behaviors meet Diagnostic and Statistical Manual of Mental Disorders Fourth Edition criteria for mental illness. Thus this study assessed psychiatrists' anticipatory guidance on firearms and their perceptions of their roles on this topic. Method: A four-wave mail and telephone statewide survey of adult psychiatrists. The main outcome measures were the portion of psychiatrists involved in anticipatory guidance on firearm safety issues and their self-efficacy and perceived barriers regarding firearm counseling. Results: A total of 207 psychiatrists out of a possible 340 (60%) responded. Psychiatrists were most likely (47%) to have discussed firearm safety issues for longer than 6 months with patients, followed by 45% had never seriously thought about discussing firearm safety issues. The psychiatrists perceived firearms safety issues to be much greater (32%) or slightly greater (37%) for mental health patients than for the general population. Psychiatrists with high efficacy expectations were twice as likely (56.5% vs. 28.0%) as those with low efficacy expectations to provide firearm anticipatory guidance. Additionally, those with high outcome expectations were 15 times (93.7% vs 6.3%) more likely to provide anticipatory guidance than those with low outcome expectations. Conclusions: Among Ohio adult psychiatrists few had a routine system for identifying patients who owned firearms, half were currently involved in anticipatory guidance regarding firearms, and they were more likely to engage in anticipatory guidance if they had high self-efficacy in firearms safety issues.