Lethal Means Restriction for Suicide Prevention: Beliefs and Behaviors of Emergency Department Providers

OBJECTIVES: To examine the beliefs and behaviors of Emergency Department (ED) providers related to means restriction for suicide prevention. METHODS: Providers at eight EDs completed an anonymous survey (June 2010-March 2011). RESULTS: The response rate was 79% (n=631); 57% were female and the median age was 35 (IQR: 30-44). Approximately half (48%) were nurses and half attending (22%) or resident (30%) physicians. Over half (56%) believed “some,” “few” or “no” suicides are preventable; more nurses (67%) than attending (43%) or resident (44%) physicians said that “most” or “all” firearm suicide decedents would have died by another method had a firearm been unavailable (p<0.001). More providers said they “almost always” ask about home firearms when a patient is suicidal with a plan involving a firearm (64%) than when suicidal without a plan (22%), suicidal with a non-firearm plan (21%), suicidal in the past month but not presently (16%), or in the ED for an overdose but no longer suicidal (9%). In multivariable logistic regression, factors associated with “almost always” asking about firearm access when a patient is suicidal, whether with a firearm or non-firearm suicide plan, were being a physician (vs. nurse) and believing one's 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 providers rarely assess a suicidal patient's firearm access except in cases of a firearm suicide plan. These findings suggest the need for targeted staff education.