When patients receiving mental health care were asked to complete a standardized questionnaire that asked whether they had access to guns, most provided a response, reports a study in JAMA Health Forum. A positive response can help clinicians identify and provide appropriate follow-up care for patients at risk of suicide.
“Firearms are the most common method of suicide, one of the ‘diseases of despair’ driving increased mortality in the U.S. over the past decade,” wrote Julie E. Richards, Ph.D., M.P.H., of Kaiser Permanente Washington in Seattle and colleagues. “However, routine standardized questions about firearm access are uncommon, particularly among adult populations, who are more often asked at the discretion of health care clinicians.”
In August 2015, Kaiser Permanente clinics in Washington state began incorporating a question about firearm access—“Do you have access to guns?”—to the standard mental health monitoring questionnaire. Richards and colleagues compiled data on 128,802 patients who completed these questionnaires at either a primary care or mental health clinic between 2016 and 2019.
Overall, 83.4% of patients in primary care clinics and 91.8% of those in mental health clinics answered the question on access; in both settings those who did not respond were more likely to be older, male, live in a rural setting, and/or have a recent substance use disorder diagnosis. Richards and colleagues noted the rates for nonresponse were much higher than rates for other sensitive questions like alcohol or drug use (between 2% and 3%).
In terms of access, 20.9% of patients in primary care clinics and 15.3% in mental health clinics reported having access to firearms. Those with access were more likely to be male and live in a rural or suburban setting. Patients who reported a previous suicide attempt were far less likely to report firearm access than those without a suicide attempt history.
“This novel study demonstrates that standard assessment of access to firearms is feasible in the context of [mental health] monitoring in [primary care] and outpatient [mental health] specialty settings,” Richards and colleagues wrote. “Asking patients to routinely self-report firearm access can help clinicians identify and engage patients at risk of suicide in dialogue regarding storage of firearms and/or ammunition (i.e., increasing time and/or distance required to access firearms), which is a recommended component of evidence-based safety planning interventions for suicide prevention.”
To read more on this topic, see the Psychiatric Services “What Will Happen If I Say Yes?” Perspectives on a Standardized Firearm Access Question Among Adults With Depressive Symptoms.”
