261911 Lethal Means Restriction for Suicide Prevention: Beliefs and Behaviors of Emergency Department Providers

Monday, October 29, 2012 : 8:30 AM - 8:50 AM

Marian E. Betz, MD, MPH , Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
Matthew Miller, MD, ScD , Health Policy and Management, Harvard School of Public Health, Boston, MA
Catherine Barber, MPA , Harvard Injury Control Research Center, Harvard School of Public Health, Boston, MA
Ivan Miller, PhD , Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI
Carlos A. Camargo Jr., MD, DrPH , Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
Edwin Boudreaux, PhD , Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA
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.

Learning Areas:
Clinical medicine applied in public health
Planning of health education strategies, interventions, and programs
Provision of health care to the public

Learning Objectives:
1. Recognize the importance of understanding emergency department providers' beliefs and behaviors towards lethal means restriction for suicide prevention. 2. Identify differences in suicide prevention beliefs and behaviors of emergency department providers by demographic and professional characteristics. 3. Discuss ways to develop targeted targeted education for providers to enhance suicide prevention approaches, including lethal means restriction.

Keywords: Suicide, Emergency Department/Room

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an emergency physician with an MPH degree and experience in injury research, publications, and presentations
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3043.0: Suicide prevention