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Stanley IH, Sachs-Ericsson NJ, Joiner TE. Suicidal ideation in the context of prospective firearm ownership. Psychiatry Res 2021; 295:113584. [PMID: 33285344 DOI: 10.1016/j.psychres.2020.113584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022]
Abstract
Most suicide deaths in the United States are enacted with a firearm, and recent and first-time purchasers of firearms represent at-risk groups. This study aimed to examine differences in indicators of suicide risk among individuals who either (a) reported current firearm ownership/access or (b) denied current firearm ownership/access but reported an intention to obtain a firearm (i.e., prospective firearm owners). Participants were 96 young adults with a lifetime history of suicidal ideation and firearm ownership, access, or interest. We assessed recent suicidal ideation severity with the Depressive Symptom Index-Suicidality Subscale (DSI-SS) and sought to internally replicate findings with the Patient Health Questionnaire (PHQ-9) item 9. Fifty-two (54.2%) participants reported firearm ownership/access and 44 (45.8%) identified as prospective firearm owners. Prospective firearm owners had significantly greater DSI-SS suicidal ideation severity scores compared with those who already own/have access to a firearm, corresponding to a medium effect size; results were consistent with the PHQ-9 suicidal ideation item. Findings of this initial investigation suggest that the intention to commence firearm ownership might represent an at-risk period, especially for individuals with a history of suicidal thinking. Replication of findings in larger and more clinically severe samples is needed.
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Affiliation(s)
- Ian H Stanley
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL, 32306, USA.
| | - Natalie J Sachs-Ericsson
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL, 32306, USA.
| | - Thomas E Joiner
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL, 32306, USA.
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Stanley IH, Hom MA, Marx BP, Reger MA. Post‐traumatic stress disorder and firearm ownership, access, and storage practices: A systematic review. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2020. [DOI: 10.1111/cpsp.12358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Valenstein M, Walters H, Pfeiffer PN, Ganoczy D, Ilgen MA, Miller MJ, Fiorillo M, Bossarte RM. Possession of Household Firearms and Firearm-Related Discussions with Clinicians Among Veterans Receiving VA Mental Health Care. Arch Suicide Res 2020; 24:260-279. [PMID: 30734648 DOI: 10.1080/13811118.2019.1572555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: To assess possession of household firearms among veterans receiving mental health care and the frequency of their discussions with clinicians about firearms. Methods: We surveyed random samples of veterans receiving mental health care in each of five purposively chosen, geographically diverse VA facilities; 677 (50% of recipients) responded. Results: 45.3% (95% CI 41.2, 49.3) of veteran respondents reported household firearms; 46.9% of those with suicidal thoughts and 55.6% with a suicide plan had household firearms. Only 27.5% of all veteran respondents and 44% of those with recent suicidal ideation and household firearms had had a firearm-related discussion with a clinician. Discussion: Many veterans receiving mental health care can readily access firearms, a highly lethal means for suicide. Increasing clinician-patient discussions and health system efforts to reduce firearm access might reduce suicide in this clinical population.
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Stanley IH, Simpson S, Wortzel HS, Joiner TE. Documenting suicide risk assessments and proportionate clinical actions to improve patient safety and mitigate legal risk. BEHAVIORAL SCIENCES & THE LAW 2019; 37:304-312. [PMID: 31063254 DOI: 10.1002/bsl.2409] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/23/2019] [Accepted: 03/29/2019] [Indexed: 06/09/2023]
Abstract
Few clinical practices are as important for simultaneously augmenting patient safety and mitigating legal risk as the judicious evaluation and stratification of a patient's risk for suicide, proportionate clinical actions based thereon taken by the healthcare provider, and contemporaneous documentation of the foregoing. In this article, we draw from our combined decades of multidisciplinary experience as a clinical psychologist, forensic psychiatrist, medical malpractice attorney, and clinical psychology trainee to discuss the documentation of suicide risk assessment and management as a conduit to patient safety and legal risk mitigation. We additionally highlight documentation as a core clinical competency across disciplines and note areas of improvement, such as increased training, to bolster documentation practices.
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Affiliation(s)
- Ian H Stanley
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | | | - Hal S Wortzel
- Departments of Psychiatry, Neurology, and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Denver, CO, USA
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Rocky Mountain Regional Medical Center, Denver, CO, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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Allchin A, Chaplin V, Horwitz J. Limiting access to lethal means: applying the social ecological model for firearm suicide prevention. Inj Prev 2018; 25:i44-i48. [PMID: 29941633 DOI: 10.1136/injuryprev-2018-042809] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/16/2018] [Indexed: 11/04/2022]
Abstract
This paper outlines a novel application of the social ecological model (SEM) for firearm suicide prevention. It focuses on four levels of intervention (societal, relationship, community and individual) to reduce access to firearms, a practical contributor to the capacity to attempt suicide, from individuals when they are at an elevated risk for suicide. There is substantive research linking easy access to firearms with an increased risk of firearm suicide, and suicide prevention interventions that address access to lethal means are critical components of a comprehensive suicide prevention strategy. Potential interventions using the SEM framework include: at the policy level-extreme risk laws, voluntary self-prohibition policies and policies that reduce the availability of firearms; at the community level-gun shop projects; at the relationship level-lethal means safety counselling; and at the individual level-safer storage. Taken together with upstream interventions, such as increased access to mental health services and substance use treatment, a multilevel approach for suicide prevention that addresses access to firearms can save lives.
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Affiliation(s)
- Adelyn Allchin
- Educational Fund to Stop Gun Violence, Washington, DC, USA
| | - Vicka Chaplin
- Educational Fund to Stop Gun Violence, Washington, DC, USA
| | - Joshua Horwitz
- Educational Fund to Stop Gun Violence, Washington, DC, USA
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Stanley IH, Hom MA, Rogers ML, Anestis MD, Joiner TE. Discussing Firearm Ownership and Access as Part of Suicide Risk Assessment and Prevention: "Means Safety" versus "Means Restriction". Arch Suicide Res 2017; 21:237-253. [PMID: 27077214 DOI: 10.1080/13811118.2016.1175395] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The goal of this study was to describe the relative utility of the terms "means safety" versus "means restriction" in counseling individuals to limit their access to firearms in the context of a mock suicide risk assessment. Overall, 370 participants were randomized to read a vignette depicting a clinical scenario in which managing firearm ownership and access was discussed either using the term "means safety" or "means restriction." Participants rated the term "means safety" as significantly more acceptable and preferable than "means restriction." Participants randomized to the "means safety" condition reported greater intentions to adhere to clinicians' recommendations to limit access to a firearm for safety purposes (F[1,367] = 7.393, p = .007, [Formula: see text]). The term "means safety" may be more advantageous than "means restriction" when discussing firearm ownership and access in clinical settings and public health-oriented suicide prevention efforts.
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Rozel JS, Mulvey EP. The Link Between Mental Illness and Firearm Violence: Implications for Social Policy and Clinical Practice. Annu Rev Clin Psychol 2017; 13:445-469. [PMID: 28375722 DOI: 10.1146/annurev-clinpsy-021815-093459] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The United States has substantially higher levels of firearm violence than most other developed countries. Firearm violence is a significant and preventable public health crisis. Mental illness is a weak risk factor for violence despite popular misconceptions reflected in the media and policy. That said, mental health professionals play a critical role in assessing their patients for violence risk, counseling about firearm safety, and guiding the creation of rational and evidence-based public policy that can be effective in mitigating violence risk without unnecessarily stigmatizing people with mental illness. This article summarizes existing evidence about the interplay among mental illness, violence, and firearms, with particular attention paid to the role of active symptoms, addiction, victimization, and psychosocial risk factors. The social and legal context of firearm ownership is discussed as a preface to exploring practical, evidence-driven, and behaviorally informed policy recommendations for mitigating firearm violence risk.
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Affiliation(s)
- John S Rozel
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213; ,
| | - Edward P Mulvey
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213; ,
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Roszko PJD, Ameli J, Carter PM, Cunningham RM, Ranney ML. Clinician Attitudes, Screening Practices, and Interventions to Reduce Firearm-Related Injury. Epidemiol Rev 2016; 38:87-110. [PMID: 26905894 PMCID: PMC7297261 DOI: 10.1093/epirev/mxv005] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 12/14/2022] Open
Abstract
Firearm injury is a leading cause of injury-related morbidity and mortality in the United States. We sought to systematically identify and summarize existing literature on clinical firearm injury prevention screening and interventions. We conducted a systematic search of PubMed, Web of Science, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycInfo, and ClinicalTrials.gov for English-language original research (published 1992-2014) on clinical screening methods, patient-level firearm interventions, or patient/provider attitudes on the same. Unrelated studies were excluded through title, abstract, and full-text review, and the remaining articles underwent data abstraction and quality scoring. Of a total of 3,260 unique titles identified, 72 were included in the final review. Fifty-three articles examined clinician attitudes/practice patterns; prior training, experience, and expectations correlated with clinicians' regularity of firearm screening. Twelve articles assessed patient interventions, of which 6 were randomized controlled trials. Seven articles described patient attitudes; all were of low methodological quality. According to these articles, providers rarely screen or counsel their patients-even high-risk patients-about firearm safety. Health-care-based interventions may increase rates of safe storage of firearms for pediatric patients, suicidal patients, and other high-risk groups. Some studies show that training clinicians can increase rates of effective firearm safety screening and counseling. Patients and families are, for the most part, accepting of such screening and counseling. However, the current literature is, by and large, not high quality. Rigorous, large-scale, adequately funded studies are needed.
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Affiliation(s)
| | | | | | | | - Megan L. Ranney
- Correspondence to Dr. Megan L. Ranney, Department of Emergency Medicine, Rhode Island Hospital/Alpert Medical School of Brown University, 593 Eddy Street, Claverick 2, Providence, RI 02903 (e-mail:)
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Psychiatric Residency Directors’ Perceptions of Firearm Access by the Mentally Ill in the United States. J Community Health 2013; 39:322-6. [DOI: 10.1007/s10900-013-9764-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Yeh DD, Hwabejire JO, Imam A, Mullen JT, Smink D, Velmahos G, DeMoya M. A survey of study habits of general surgery residents. JOURNAL OF SURGICAL EDUCATION 2013; 70:15-23. [PMID: 23337665 DOI: 10.1016/j.jsurg.2012.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Revised: 08/13/2012] [Accepted: 08/20/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To understand the study habits of general surgery residents as well as their motivating factors for study. DESIGN A survey was mailed to general surgical residents. Performance on the American Board of Surgery In-Training Examination (ABSITE) was correlated with reported study habits using the Pearson's correlation coefficient. SETTING Massachusetts General Hospital and Brigham and Women's Hospital, 2 urban tertiary referral academic training institutions in Boston, Massachusetts. PARTICIPANTS Fifty-eight general surgical residents of all training levels (including research). RESULTS On average, surgical residents studied for 3 ± 1 days per week, the average duration of each study session being 1.3 ± 0.6 hours. The average total number of study hours per week was 3.4 ± 2.3. There were strong positive correlations between increased study frequency and high overall ABSITE score (Pearson's r = 0.339; p = 0.02) and between the total number of study hours per week and high overall ABSITE score (Pearson's r = 0.423; p < 0.005). Only 10% and 3% reported complete satisfaction with current study materials and routine, respectively. Most residents (96%) reported a willingness to try a new type of study method and 75% were willing to enroll in a trial comparing study methods. CONCLUSIONS Increased study frequency and overall increased study duration are positively correlated with ABSITE performance. Dissatisfaction with current study materials and study routine is high, as is willingness to adopt new methods and enroll in investigational trials comparing study methods.
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Affiliation(s)
- Daniel Dante Yeh
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Khubchandani J, Wiblishauser M, Price JH, Thompson A. Graduate psychiatric nurse's training on firearm injury prevention. Arch Psychiatr Nurs 2011; 25:245-52. [PMID: 21784283 DOI: 10.1016/j.apnu.2010.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Revised: 07/09/2010] [Accepted: 07/19/2010] [Indexed: 01/09/2023]
Abstract
Psychiatric nurses should be uniquely positioned for helping to prevent firearm suicides and homicides among the mentally ill. This study assessed the prevalence of firearm injury prevention training in graduate psychiatric nursing training programs through a three-wave mail survey of program directors. Most (87%) of the directors reported that they had not seriously thought about providing firearm injury prevention training. Almost half (48%) reported they did not routinely screen patients for firearm ownership. In addition, most (66%) thought that the American Psychiatric Nurses Association (APNA) should provide curriculum guidelines regarding firearm injury prevention training. Leadership is needed by the APNA to help reduce firearm violence in the mentally ill.
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Affiliation(s)
- Jagdish Khubchandani
- Department of Physiology and Health Sciences, Ball State University, Muncie, IN, USA.
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