Thursday, March 15, 2018

Nondisclosure of Suicidal Intent Following Gunshot Wound Presents Barrier to Care, Study Finds

Some survivors of self-inflicted gunshot wounds falsely deny their injuries are a result of a suicide attempt. According to a study published today in Psychiatric Services in Advance, these patients are far less likely to receive inpatient psychiatric care following their injury than those who disclose suicidal intent.

The results highlight the importance of increased assessment, intervention, and psychoeducation for survivors of self-inflicted gunshot wounds, particularly while they are hospitalized on medical floors, wrote Michael Matthew McClay, M.S., of Western Kentucky University, Stephen S. O'Connor, Ph.D., of the University of Louisville, and colleagues. Because survivors of suicide attempts are at high risk of recurrence, correctly identifying these individuals is critical so treatment and prevention efforts can ensue, wrote the authors.

About 44,000 people die by suicide every year in the United States, making it the 10th most common cause of death. Suicide attempts occur at an even greater rate and result in more than 316,000 hospital admissions and $51 billion in combined costs of medical care and loss of work each year, the authors wrote.

The researchers examined electronic medical record data from 128 survivors of self-inflicted gunshot wounds at a trauma center in Tennessee; more than 25% of these patients were known to have made a prior suicide attempt.

Overall, 71% of the survivors of self-inflicted gunshot wounds disclosed that it was a suicide attempt, and 29% denied it. Of patients who denied the suicide attempt, about 40% (16 patients) were flagged during a psychiatric consultation as presenting under circumstances suspicious of a suicide attempt. Suicide attempt was suspected in some cases due to reports from witnesses or conflicting stories by the patients regarding the circumstances of their injury, for instance.

Patients who denied their suicide attempt were more than 10 times more likely to be discharged to home than to inpatient care, compared with patients who disclosed an attempt, the study found.

“Within acute care center settings, the desire to avoid inpatient psychiatric hospitalization and documentation in the medical record may be barriers to reporting that a self-inflicted gunshot wound was intentional,” the researchers wrote. “[T]he results indicate a need for further reflection on ways in which usual care in health systems (such as inpatient hospitalization) may present a barrier for eliciting honest reports from suicide attempt survivors due to a fear of hospitalization.”

For related information, see the book Gun Violence and Mental Illness, co-edited by Liza Gold, M.D., and Robert I. Simon, M.D.

(Image: iStock/robypangy)


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