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Boggs JM, Quintana LM, Beck A, Clarke CL, Richardson L, Conley A, Buckingham ET, Richards JE, Betz ME. A Randomized Control Trial of a Digital Health Tool for Safer Firearm and Medication Storage for Patients with Suicide Risk. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:358-368. [PMID: 38206548 DOI: 10.1007/s11121-024-01641-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 01/12/2024]
Abstract
Most patients with suicide risk do not receive recommendations to reduce access to lethal means due to a variety of barriers (e.g., lack of provider time, training). Determine if highly efficient population-based EHR messaging to visit the Lock to Live (L2L) decision aid impacts patient-reported storage behaviors. Randomized trial. Integrated health care system serving Denver, CO. Served by primary care or mental health specialty clinic in the 75-99.5th risk percentile on a suicide attempt or death prediction model. Lock to Live (L2L) is a web-based decision aid that incorporates patients' values into recommendations for safe storage of lethal means, including firearms and medications. Anonymous survey that determined readiness to change: pre-contemplative (do not believe in safe storage), contemplative (believe in safe storage but not doing it), preparation (planning storage changes) or action (safely storing). There were 21,131 patients randomized over a 6-month period with a 27% survey response rate. Many (44%) had access to a firearm, but most of these (81%) did not use any safe firearm storage behaviors. Intervention patients were more likely to be categorized as preparation or action compared to controls for firearm storage (OR = 1.30 (1.07-1.58)). When examining action alone, there were no group differences. There were no statistically significant differences for any medication storage behaviors. Selection bias in those who responded to survey. Efficiently sending an EHR invitation message to visit L2L encouraged patients with suicide risk to consider safer firearm storage practices, but a stronger intervention is needed to change storage behaviors. Future studies should evaluate whether combining EHR messaging with provider nudges (e.g., brief clinician counseling) changes storage behavior.ClinicalTrials.gov: NCT05288517.
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Affiliation(s)
- Jennifer M Boggs
- Kaiser Permanente Colorado, Institute for Health Research, 2550 S Parker Rd., Aurora, CO, 80014, USA.
| | - LeeAnn M Quintana
- Kaiser Permanente Colorado, Institute for Health Research, 2550 S Parker Rd., Aurora, CO, 80014, USA
| | - Arne Beck
- Kaiser Permanente Colorado, Institute for Health Research, 2550 S Parker Rd., Aurora, CO, 80014, USA
| | - Christina L Clarke
- Kaiser Permanente Colorado, Institute for Health Research, 2550 S Parker Rd., Aurora, CO, 80014, USA
| | - Laura Richardson
- Department of Behavioral Health Services, Kaiser Permanente Colorado, 10350 E Dakota Ave. #125, Denver, CO, 80247, USA
| | - Amy Conley
- Department of Behavioral Health Services, Kaiser Permanente Colorado, 10350 E Dakota Ave. #125, Denver, CO, 80247, USA
| | - Edward T Buckingham
- Department of Behavioral Health Services, Kaiser Permanente Colorado, 10350 E Dakota Ave. #125, Denver, CO, 80247, USA
- Colorado Permanente Medical Group, Kaiser Permanente Colorado, 1835 Franklin St., Denver, CO, 80218, USA
| | - Julie E Richards
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Seattle, WA, 98101, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, 12505 E. 16th Ave., Anschutz Inpatient Pav. 2, 1st floor, Aurora, CO, 80045, USA
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Lengvenyte A, Giner L, Jardon V, Olié E, Perez V, Saiz P, Gonzalez Pinto A, Courtet P. Assessment and management of individuals consulting for a suicidal crisis: A European Delphi method-based consensus guidelines. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023:S2950-2853(23)00113-8. [PMID: 38158127 DOI: 10.1016/j.sjpmh.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Managing patient with suicidal thoughts and behaviours presents significant challenges due to the scarcity of robust evidence and clear guidance. This study sought to develop a comprehensive set of practical guidelines for the assessment and management of suicidal crises. MATERIALS AND METHODS Utilizing the Delphi methodology, 80 suicide clinician and research experts agreed on a series of recommendations. The process involved two iterative rounds of surveys to assess agreement with drafted recommendations, inviting panellists to comment and vote, culminating in 43 consensus recommendations approved with at least 67% agreement. These consensus recommendations fall into three main categories: clinical assessment, immediate care, and long-term approaches. RESULTS The panel formulated 43 recommendations spanning suicidal crisis recognition to continuous long-term care. These guidelines underscore systematic proactive suicide risk screening, in-depth medical and toxicological assessment, and suicide risk appraisal considering personal, clinical factors and collateral information from family. The immediate care directives emphasize a secure environment, continuous risk surveillance, collaborative decision-making, including potential hospitalization, sensible pharmacological management, safety planning, and lethal means restriction counselling. Every discharge should be accompanied by prompt follow-up care incorporating proactive case management and multi-modal approach involving crisis lines, brief contact, and psychotherapeutic and pharmacological interventions. CONCLUSIONS This study generated comprehensive guidelines addressing care for individuals in suicidal crises, covering pre- to post-discharge care. These practical recommendations can guide clinicians in managing patients with suicidal thoughts and behaviours, improve patient safety, and ultimately contribute to the prevention of future suicidal crises.
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Affiliation(s)
- Aiste Lengvenyte
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France; Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Lucas Giner
- Department of Psychiatry, Universidad de Sevilla, Seville, Spain
| | - Vincent Jardon
- CHU Lille, Hôpital Fontan, Service de Psychiatrie Adulte, Lille, France
| | - Emilie Olié
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Victor Perez
- Institute of Neuropsychiatry and Addiction (Institut de Neuropisiquiatria i Addiccions), Parc de Salut Mar, Barcelona, Spain; CIBERSAM (Mental Health Networking Biomedical Research Centre), Spain
| | - Pilar Saiz
- CIBERSAM (Mental Health Networking Biomedical Research Centre), Spain; Department of Psychiatry, University of Oviedo, Oviedo, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Ana Gonzalez Pinto
- CIBERSAM (Mental Health Networking Biomedical Research Centre), Spain; Department of Psychiatry, BIOARABA, Araba University Hospital, University of the Basque Country, Vitoria, Spain; Faculty of Medicine, Department of Neurosciences, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France
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Salhi C, Beatriz E, Berrigan J, Azrael D, Houston A, Runyan C, Barber C, Betz M, Miller M. "Your son needs help … and we're gonna help him": A qualitative study of the experiences of gun-owning caregivers of adolescents receiving lethal means counseling in the emergency department. Soc Sci Med 2023; 335:116218. [PMID: 37738913 DOI: 10.1016/j.socscimed.2023.116218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/17/2023] [Accepted: 09/01/2023] [Indexed: 09/24/2023]
Abstract
Suicide attempts in adolescents are often transient and unpredictable, making preventative approaches crucial in reducing suicide deaths. One important approach is lethal means counseling (LMC), in which clinicians counsel caregivers to reduce access to methods used in suicide, specifically firearms and medications. Research on LMC has increasingly encouraged the use of the shared decision-making (SDM) model, which emphasizes information exchange, collaborative deliberation, and joint planning between caregivers and clinicians. We examine caregivers' experiences with LMC, using the SDM model as our analytic framework. We conducted qualitative interviews with 21 firearm-owning caregivers of adolescents who came to emergency departments (EDs) in Colorado for a behavioral health complaint. The implementation of LMC at these institutions had three central components: training for clinicians, materials (e.g., lockboxes and pamphlets) to support LMC, and the protocolization of LMC at the institution. Our semi-structured, hour-long interviews examined participants' reflections on and reactions to LMC provided in the ED and how that related to changes in their understanding of their medication and gun storage practices. We analyzed interviews using a phenomenological approach, focusing on experiences with LMC and informed by the tenets of the SDM model. Our analysis revealed that caregivers were receptive to the idea of LMC in the pediatric emergency care setting. Caregivers' engagement in LMC was reinforced by experiences with clinicians who sought to understand the circumstances of their household, shared the motivation behind LMC, and facilitated conversation around a shared concern for the child's safety. In contrast, counseling delivered mechanically and without considering the household context was tied to caregivers' confusion and alienation, both for LMC and their consideration of changes to home storage practices. These findings provide insight into adolescent caregivers' experiences with LMC implemented in EDs and how LMC may best be approached.
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Affiliation(s)
- Carmel Salhi
- Department of Health Sciences, Northeastern University, Boston, MA, USA; Institute of Health Equity and Social Justice Research, Northeastern University, Boston, USA.
| | | | - John Berrigan
- University of Kansas School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA; Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA, USA.
| | - Deb Azrael
- Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA, USA.
| | - Ashley Houston
- Institute of Health Equity and Social Justice Research, Northeastern University, Boston, USA.
| | - Carol Runyan
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
| | - Catherine Barber
- Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA, USA.
| | - Marian Betz
- Injury and Violence Prevention Center, Colorado School of Public Health, Aurora, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Matthew Miller
- Department of Health Sciences, Northeastern University, Boston, MA, USA; Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA, USA.
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Stegall CL, Allen KW, Andrews AL, Kwon SJ, Oddo ER. Access to Firearms: Initiation of Firearm Screening Among Psychiatric Patients in a Pediatric Emergency Department. Acad Pediatr 2023; 23:1426-1433. [PMID: 37302700 DOI: 10.1016/j.acap.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Increase provider screening rates for firearm access among patients presenting to the pediatric emergency department (PED) for a psychiatric chief complaint. METHODS In this resident-driven quality improvement project, a retrospective chart review examined firearm access screening rates among patients presenting to the PED with the chief complaint of "psychiatric evaluation." After establishing our baseline screening rate, the first phase of our plan, do, study, act (PDSA) cycle included implementing Be SMART education for pediatric residents. We made Be SMART handouts available in the PED, created electronic medical record (EMR) templates to facilitate documentation, and emailed routine reminders to residents during their PED block. In the second PDSA cycle, the pediatric emergency medicine (PEM) fellows expanded our efforts to increase project awareness from a supervisory role. RESULTS The baseline screening rate was 14.7% (50 of 340). After PDSA 1, a center line shift occurred, and screening rates increased to 34.3% (297 of 867). After PDSA 2, screening rates increased to 35.7% (226 of 632). In the intervention phase, providers who received training screened 39.5% (238 of 603) of encounters versus providers who did not receive training screened 30.8% (276 of 896) of encounters. Of all encounters screened, 39.2% (205 of 523) screened positive for in-home firearms. CONCLUSIONS We improved firearm access screening rates in the PED using provider education, EMR prompts, and PEM fellow participation. Opportunities remain to promote firearm access screening and secure storage counseling in the PED.
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Affiliation(s)
- Cassandra L Stegall
- Eastern Virginia Medical School (CL Stegall), Children's Hospital of the King's Daughters, Norfolk.
| | - Kelsey W Allen
- Emory University, Department of Pediatric Emergency Medicine (KW Allen), Atlanta, Ga
| | - Annie L Andrews
- Medical University of South Carolina, Department of Pediatrics (AL Andrews, SJ Kwon, ER Oddo), Charleston
| | - Stephanie J Kwon
- Medical University of South Carolina, Department of Pediatrics (AL Andrews, SJ Kwon, ER Oddo), Charleston
| | - Elizabeth R Oddo
- Medical University of South Carolina, Department of Pediatrics (AL Andrews, SJ Kwon, ER Oddo), Charleston
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Abstract
Suicide rates continue to rise, and clinicians and mental health staff play a critical role in keeping suicidal clients safe. Safety planning, including means safety, may help to decrease suicide risk. Unfortunately, availability and evaluation of safety planning training for these providers are scarce. The goal of the present study was to evaluate a safety planning training, LINC to LIFE Safety Planning (L2L SP). L2L SP is a 150-minute, face-to-face training program that teaches providers to engage clients in collaborative safety planning and means safety efforts, facilitate diverse client coping strategies, problem-solve, and involve close others, among other skills. These objectives are achieved through interactive content delivery, role-play, and corrective feedback. L2L SP was administered to 95 participants. Key determinants of behavioral change (e.g., knowledge, attitudes, perceived behavioral control [PBC]) were measured at pre, post, and six-month follow-up. Additionally, participants' behaviors and emotions in working with suicidal clients were measured at pretest and six-month follow-up. Paired sample t-tests, repeated measures MANOVA, and univariate ANOVAs with post-hoc testing using Bonferroni correction were conducted. Results supported significant improvements in knowledge, PBC, and intentions at post-test, and attitudes, PBC, and effective emotional responses at follow-up. Exploratory analyses suggested significant improvements in behaviors among clinicians and mental health staff who saw clients reporting suicidal ideation. The present study provides promising results regarding brief safety planning training. Declines in knowledge and PBC following the training highlight the potential need for booster sessions or more intensive initial training in these areas.HighlightsThe present study evaluated a comprehensive, interactive safety planning training.Knowledge, PBC, and intentions were significantly improved at post-test.Attitudes, PBC, and emotions were significantly improved at follow-up.
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Khazanov GK, Keddem S, Hoskins K, Myhre K, Sullivan S, Mitchell E, Holliman BD, Landes SJ, Simonetti J. Stakeholder perceptions of lethal means safety counseling: A qualitative systematic review. Front Psychiatry 2022; 13:993415. [PMID: 36339871 PMCID: PMC9634731 DOI: 10.3389/fpsyt.2022.993415] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/29/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Lethal means safety counseling (LMSC) is an evidence-based suicide prevention intervention during which providers encourage patients to limit their access to lethal means (e.g., firearms, medications). Despite agreement about the importance of LMSC, it is underutilized in clinical practice. METHODS To better understand the individual and contextual factors that influence LMSC and its implementation, we conducted a systematic review of qualitative studies examining stakeholder perceptions of the intervention. PubMed and PsycInfo were searched up to February 2021 using terms related to: (1) LMSC, firearms, or medications; (2) suicide, safety, or injury; and (3) qualitative methodology. Two coders used thematic synthesis to analyze findings from eligible papers, including developing a codebook and coding using an inductive and iterative approach (reliability k > 0.70). Confidence in review findings were evaluated using the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) Approach. Subthemes were assigned to domains in the Consolidated Framework for Implementation Research. FINDINGS Of the 19 papers identified, 18 discussed LMSC for firearms and 1 focused exclusively on LMSC for medications. The firearm-related studies explored perspectives of a variety of stakeholders (patients, providers, members of the firearms community, healthcare leaders, and family members) across multiple settings (emergency departments, pediatric and adult primary care, and outpatient mental health). Seven overarching themes emerged, including the: (1) importance of firearms to owners' identities and perceptions of ownership as a value and right, which can lead to perceived cultural tensions in clinical settings; (2) importance of patients understanding the context and rationale for LMSC; (3) value of providers showing cultural competency when discussing firearms; (4) influence of safety and risk beliefs on firearm behaviors; (5) need to navigate logistical concerns when implementing LMSC; (6) value of individualizing LMSC; (7) potential for trusted family members and friends to be involved in implementing LMSC. CONCLUSION This synthesis of the qualitative literature informs clinical, operational, and research endeavors aimed at increasing the reach and effectiveness of LMSC. Future research should address the perspectives of individuals underrepresented in the literature (e.g., those from racial/ethnic minority groups) and further examine stakeholders' perceptions of LMSC for medication. [-2pt]. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021237515], identifier [CRD42021237515].
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Affiliation(s)
- Gabriela Kattan Khazanov
- Mental Illness Research, Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Shimrit Keddem
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia PA, United States
| | - Katelin Hoskins
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Karoline Myhre
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Sarah Sullivan
- James J. Peters VA Medical Center, Bronx, NY, United States
| | - Emily Mitchell
- James J. Peters VA Medical Center, Bronx, NY, United States
| | - Brooke Dorsey Holliman
- Department of Family Medicine, University of Colorado Anschutz School of Medicine, Aurora, CO, United States
| | - Sara J Landes
- Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, Little Rock, AR, United States.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Joseph Simonetti
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States.,Division of Hospital Medicine, University of Colorado Anschutz School of Medicine, Aurora, CO, United States
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Massey AE, Borghesani P, Stuber J, Ratzliff A, Rivara FP, Rowhani-Rahbar A. Lethal Means Assessment in Psychiatric Emergency Services: Frequency and Characteristics of Assessment. Arch Suicide Res 2022; 26:112-126. [PMID: 32585123 DOI: 10.1080/13811118.2020.1783411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Lethal means safety is an effective suicide prevention strategy with demonstrated results at the population level, yet individual-level uptake is less well understood. METHODS Using automated data extraction methods, we conducted an investigation of electronic health records from psychiatric emergency service (PES) patients from January 1, 2012 to December 31, 2017 at a busy urban medical center in the Pacific Northwest. At each PES mental health evaluation, every patient received a Suicide Risk Assessment during which providers used an electronic template with standardized fields to record lethal means access and other suicide risk factors. RESULTS We assessed 32,658 records belonging to 15,652 patients. Among all visits, 69.9% (n = 22,824) had some documentation of lethal means assessment. However, 54.1% (n = 17,674) of all visits lacked some or all potential documentation detail. Additionally, among 59.6% of visits in which a patient had documented access to lethal means, the specific means available were not indicated. Across the twenty risk and demographic factors we assessed, the prevalence of documentation did not vary by any given risk factor and only varied minimally by age and race. For example, when comparing visits which indicated family history of suicide to those which indicated no family history of suicide, the prevalence ratio was 0.99 (95% CI: 0.95, 1.03). CONCLUSION Despite the high-risk patient population, mental health focus of the facility, and the presence of a standardized tool, lethal means documentation was suboptimal. In alignment with recent recommendations, our findings indicate that additional focus on implementation is needed to improve documentation of lethal means assessment.HighlightsFifteen times larger than prior comparable studiesFindings demonstrate persistent under-documentation patterns in new setting and regionStandardized methods likely needed to improve documentation detail and frequency.
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Asarnow JR, Zullo L, Ernestus SM, Venables CW, Goldston DB, Tunno AM, Betz ME. "Lock and Protect": Development of a Digital Decision Aid to Support Lethal Means Counseling in Parents of Suicidal Youth. Front Psychiatry 2021; 12:736236. [PMID: 34690841 PMCID: PMC8528190 DOI: 10.3389/fpsyt.2021.736236] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/27/2021] [Indexed: 12/31/2022] Open
Abstract
Objective: Reducing access to lethal methods is an effective suicide prevention strategy that is often neglected in routine care. Digital interventions have shown promise for addressing such gaps in care; and decision aids have proven useful for supporting complicated health-related decisions, like those involving lethal means restriction. This article describes a parent/caregiver-facing web-based decision aid, the development process, and user testing. Method: A user-centered, participatory, mixed methods development design was employed. Beginning with an adult-focused decision aid developed by members of our team, we assessed ten iterations of the parent/caregiver decision aid with stakeholders (N = 85) using qualitative interviews and quantitative surveys. Stakeholders included: parents/caregivers whose children had histories of suicidal episodes before age 25, young adults with histories of suicidal thoughts/behaviors, firearm owners/representatives from firearm stores/ranges/groups, mental and medical health care providers, and emergency responders. Results: The final "Lock and Protect" decision aid was viewed as "useful for changing access to lethal means" by 100% of participants. Ninety-four percent of participants rated the information on reducing access to lethal means as good to excellent, and 91% rated the information on storage options as good to excellent. Qualitative feedback underscored a preference for offering this digital tool with a "human touch," as part of safety and discharge planning. Conclusions: "Lock and Protect" is a user-friendly web-based tool with potential for improving rates of lethal means counseling for parents/caregivers of suicidal youth and ultimately reducing pre-mature deaths by suicide.
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Affiliation(s)
- Joan R Asarnow
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lucas Zullo
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Chase W Venables
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - David B Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Angela M Tunno
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States
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Lyons VH, DeCou CR, Niehoff E, Moore M, Rivara FP, Rowhani-Rahbar A. Life experiences preceding high lethality suicide attempts in adolescents at a level I regional trauma center. Suicide Life Threat Behav 2021; 51:836-843. [PMID: 33665874 DOI: 10.1111/sltb.12740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/31/2020] [Accepted: 01/04/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe life experiences associated with patterns of medically treated and documented self-directed violence among youth who attempted suicide using highly lethal means to understand precipitating factors among youth using such lethal means. METHOD Using data from a regional, level 1 Trauma center, we identified all youth suicide attempt survivors who received treatment from 2010 to 2018 for a suicide attempt with a firearm, hanging, or jump from height injury (n = 42). We described differences in patient demographics and life experiences associated with patterns of self-directed violence by suicide attempt mechanism. We additionally assessed mechanisms used in any prior suicide attempts to identify potential increasing lethality of mechanism selection. RESULTS There were 42 eligible patients included, of whom 40.5% attempted suicide with a firearm, 26.2% with hanging, 33.3% with jumping injury. A greater proportion of patients with firearm injuries endorsed social support and had fewer preparatory acts, history of self-harming behavior, prior suicide behaviors, and fewer prior attempts compared to patients who attempted suicide with other mechanisms. CONCLUSIONS Given our findings, means safety should remain a key strategy to prevent highly lethal suicidal behavior among adolescents, especially with firearms, given that such attempts may occur prior to formal contact with mental health services.
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Affiliation(s)
- Vivian H Lyons
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA.,Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
| | - Christopher R DeCou
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.,Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Elizabeth Niehoff
- Massachusetts General Hospital, Cancer Center Protocol Office, Boston, MA, USA
| | - Megan Moore
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.,School of Social Work, University of Washington, Seattle, WA, USA
| | - Frederick P Rivara
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.,Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Ali Rowhani-Rahbar
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
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Hunter AA, DiVietro S, Boyer M, Burnham K, Chenard D, Rogers SC. The practice of lethal means restriction counseling in US emergency departments to reduce suicide risk: a systematic review of the literature. Inj Epidemiol 2021; 8:54. [PMID: 34517912 PMCID: PMC8436499 DOI: 10.1186/s40621-021-00347-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide is a leading cause of death in the US. Lethal means restriction (LMR), which encourages limiting access and reducing the lethality of particular methods of suicide, has been identified as a viable prevention strategy. For this approach to be successful, adequate education about risks and means must be communicated to families and individuals at risk for suicide. This systematic review aims to identify LMR methods most commonly communicated by healthcare providers in the emergency department, and barriers to the delivery of such counseling. METHODS The protocol for this systematic review is registered with PROSPERO (CRD42018076734). Included studies were identified through searching four databases (PubMed, Scopus, PsycInfo, and EBSCO). Studies were selected and coded independently by two researchers using the PICOS framework. Included studies examined LMR counseling delivered in the ED regardless of patient age, sex or race/ethnicity. RESULTS A total of 1282 studies were screened; 9 met the inclusion criteria. Included studies were published from 1998 to 2020. Study participants were majority female, and safe firearm storage was the most common form of LMR counseling provided. Eight studies included counseling on multiple forms of lethal means, [e.g., alcohol, medication, and firearm storage] and one study focused solely on safe firearm storage. Two studies reported barriers limiting healthcare providers' delivery of LMR counseling, including lack of specialized skills and skepticism regarding the effectiveness of LMR counseling. CONCLUSION There is limited published evidence that identifies the most effective methods and target populations for LMR counseling. Given the growing literature that provides evidence of gender differences in suicide modality (e.g., guns, medications, suffocation), LMR counseling should be multifaceted, to address common means of suicide in both men and women. Despite evidence that the majority of suicide attempts and half of completed suicides do not involve firearms, results showed that LMR counseling is frequently focused on promoting the safe storage of firearms. This highlights the need to include counseling focused on a variety of lethal means to reduce risk of suicide completion. Prospective studies should also aim to identify the most efficacious methods of delivering LMR counseling in the clinical settings.
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Affiliation(s)
- Amy A Hunter
- Department of Public Health Sciences, UCONN Health, 195 Farmington Ave, Suite 2100, Room U2012, Farmington, CT, 06030, USA. .,Injury Prevention Center, Connecticut Children's and Hartford Hospital, Hartford, CT, USA. .,Department of Pediatrics, UCONN Health, Farmington, CT, USA.
| | - Susan DiVietro
- Injury Prevention Center, Connecticut Children's and Hartford Hospital, Hartford, CT, USA.,Department of Pediatrics, UCONN Health, Farmington, CT, USA
| | - Megan Boyer
- The Robert Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | | | - Danielle Chenard
- Injury Prevention Center, Connecticut Children's and Hartford Hospital, Hartford, CT, USA.,Department of Pediatrics, UCONN Health, Farmington, CT, USA
| | - Steven C Rogers
- Injury Prevention Center, Connecticut Children's and Hartford Hospital, Hartford, CT, USA.,Department of Pediatrics, UCONN Health, Farmington, CT, USA
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11
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Siry BJ, Knoepke CE, Ernestus SM, Matlock DD, Betz ME. Lethal Means Counseling for Suicidal Adults in the Emergency Department: A Qualitative Study. West J Emerg Med 2021; 22:471-477. [PMID: 34125016 PMCID: PMC8203001 DOI: 10.5811/westjem.2021.8.49485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 03/08/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Lethal means counseling (to reduce access to firearms or other suicide methods) is a recommended critical yet challenging component of care of suicidal patients. Questions remain about communication strategies for those in acute crisis. Methods This qualitative study was an analysis of semi-structured interviews with English-speaking, community-dwelling adults with a history of lived-experience of suicidal ideation or attempts in themselves or a family member. We used a mixed inductive and deductive approach to identify descriptive themes related to communication and decision-making. Results Among 27 participants, 14 (52%) had personal and 23 (85%) had family experience with suicide ideation or attempts. Emergent themes fell into two domains: (1) communication in a state of high emotionality; and (2) specific challenges in communication: initiating, maintaining engagement, considering context. Conclusion Engaging suicidal individuals in lethal means counseling may be more effective when messaging and approaches consider their emotional state and communication challenges.
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Affiliation(s)
- Bonnie J Siry
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado
| | - Christopher E Knoepke
- University of Colorado School of Medicine, Division of Cardiology, Aurora, Colorado.,University of Colorado School of Medicine, Adult & Child Consortium for Outcomes Research & Delivery Science, Aurora, Colorado.,University of Southern California, USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California
| | | | - Daniel D Matlock
- University of Colorado School of Medicine, Adult & Child Consortium for Outcomes Research & Delivery Science, Aurora, Colorado.,University of Colorado School of Medicine, Department of Geriatric Medicine, Aurora, Colorado.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado
| | - Marian E Betz
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado
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12
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Jardon V, Cleva É, Decoster S, Lamotte A, Debien C. [Preventing suicidal crisis and suicide]. REVUE DE L'INFIRMIERE 2021; 70:29-31. [PMID: 33832726 DOI: 10.1016/j.revinf.2021.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Suicide is not the inevitable outcome of a suicidal crisis. The people concerned are most often sensitive to preventive actions, which can prevent them from committing self-destructive acts. Preventing the suicidal crisis and suicide requires the involvement of healthcare professionals. It is also everyone's business.
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Affiliation(s)
- Vincent Jardon
- Hôpital Michel-Fontan 1 et 2, rue André-Verhaeghe, CHRU de Lille, 59037 Lille cedex, France.
| | - Élise Cleva
- Hôpital Michel-Fontan 1 et 2, rue André-Verhaeghe, CHRU de Lille, 59037 Lille cedex, France
| | - Stéphanie Decoster
- Hôpital Michel-Fontan 1 et 2, rue André-Verhaeghe, CHRU de Lille, 59037 Lille cedex, France
| | - Alexia Lamotte
- Hôpital Michel-Fontan 1 et 2, rue André-Verhaeghe, CHRU de Lille, 59037 Lille cedex, France
| | - Christophe Debien
- Hôpital Michel-Fontan 1 et 2, rue André-Verhaeghe, CHRU de Lille, 59037 Lille cedex, France; Centre national de ressources et de résilience (CN2R), 103, boulevard de la Liberté, 59000 Lille, France
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13
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Affiliation(s)
- Helen M. Stallman
- School of Social Sciences, University of the Sunshine Coast, Maroochydore DC, QLD, Australia,
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14
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Farcy DA, Doria N, Moreno-Walton L, Gordon H, Sánchez J, Cubeddu LX, Ranney ML. Emergency Physician Survey on Firearm Injury Prevention: Where Can We Improve? West J Emerg Med 2021; 22:257-265. [PMID: 33856309 PMCID: PMC7972360 DOI: 10.5811/westjem.2020.11.49283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/16/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Firearm injury and death is increasingly prevalent in the United States. Emergency physicians (EP) may have a unique role in firearm injury prevention. The aim of this study was to describe EPs' beliefs, attitudes, practices, and barriers to identifying risk of and counseling on firearm injury prevention with patients. A secondary aim was assessment of perceived personal vulnerability to firearm injury while working in the emergency department (ED). METHODS We conducted a cross-sectional survey of a national convenience sample of EPs, using questions adapted from the American College of Surgeons' Committee on Trauma 2017 survey of surgeons. Descriptive statistics and chi-square tests were calculated as appropriate. RESULTS A total of 1901 surveys were completed by EPs from across the United States. Among respondents, 42.9% had a firearm at home, and 56.0% had received firearm safety training. Although 51.4% of physicians in our sample were comfortable discussing firearm access with their high-risk patients, more than 70% agreed or strongly agreed that they wanted training on procedures to follow when they identify that a patient is at high risk of firearm injury. Respondents reported a variety of current practices regarding screening, counseling, and resource use for patients at high risk of firearm injury; the highest awareness and self-reported screening and counseling on firearm safety was with patients with suicidal ideation. Although 92.3% of EPs reported concerns about personal safety associated with firearms in the ED, 48.1% reported that there was either no protocol for dealing with a firearm in the ED, or if there was a protocol, they were not aware of it. Differences in demographics, knowledge, attitudes, and behavior were observed between respondents with a firearm in the home, and those without a firearm in the home. CONCLUSIONS Among respondents to this national survey of a convenience sample of EPs, approximately 40% had a firearm at home. The majority reported wanting increased education and training to identify and counsel ED patients at high risk for firearm injury. Improved guidance on personal safety regarding firearms in the ED is also needed.
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Affiliation(s)
- David A Farcy
- Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida.,Florida International University Herbert Wertheim College of Medicine, Department of Emergency Medicine & Critical Care, Miami Florida
| | - Nicole Doria
- Dalhousie University, School of Health and Human Performance, Halifax, Canada
| | - Lisa Moreno-Walton
- Louisiana State University Health Sciences Center, Department of Emergency Medicine, New Orleans, Louisiana
| | - Hannah Gordon
- Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida
| | - Jesus Sánchez
- NOVA Southeastern University, Department of Socio Behavioral Sciences, COP, Davie, Florida
| | - Luigi X Cubeddu
- NOVA Southeastern University, Department of Pharmaceutical Sciences, COP, Davie, Florida
| | - Megan L Ranney
- Brown University, Alpert Medical School, Department of Emergency Medicine, Providence, Rhode Island
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15
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Diurba S, Johnson RL, Siry BJ, Knoepke CE, Suresh K, Simpson SA, Azrael D, Ranney ML, Wintemute GJ, Betz ME. Lethal Means Assessment and Counseling in the Emergency Department: Differences by Provider Type and Personal Home Firearms. Suicide Life Threat Behav 2020; 50:1054-1064. [PMID: 32598076 PMCID: PMC7722150 DOI: 10.1111/sltb.12649] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/09/2020] [Accepted: 04/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined emergency department (ED) and behavioral health (BH) provider attitudes and behaviors related to lethal means screening and counseling of patients with suicide risk, specifically examining differences by provider type and whether providers had firearms in their own home. METHODS Emergency department providers (physicians and mid-level practitioners) and behavioral health (BH) providers at four Colorado EDs completed an anonymous, web-based survey. RESULTS Fewer ED providers (35%) than BH providers (81%) felt confident in their ability to counsel patients about lethal means (p < .001). In multivariable analysis, the only clinical or provider factor associated with often or almost always asking patients about firearm access was provider type, with BH providers more likely than ED providers to ask in all scenarios (OR: 5.58, 95% CI 1.68-18.6). Behaviors and attitudes about lethal means counseling did not vary by whether the provider had firearms at home. Almost all providers said that additional training and protocols about how to help patients make firearm storage decisions would be helpful. CONCLUSIONS Gaps in ED-delivered lethal means counseling persist, highlighting directions for future provider education and protocol development.
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Affiliation(s)
- Sofiya Diurba
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rachel L. Johnson
- Department of Biostatistics and Informatics, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Bonnie J. Siry
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christopher E. Knoepke
- Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA,Adult & Child Consortium for Outcomes Research & Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Krithika Suresh
- Department of Biostatistics and Informatics, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA,Adult & Child Consortium for Outcomes Research & Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Scott A. Simpson
- Psychiatric Emergency Services, Denver Health, Denver, Colorado, USA and Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Deborah Azrael
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Megan L. Ranney
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Garen J Wintemute
- Violence Prevention Research Program, University of California Davis, Sacramento, California, USA
| | - Marian E. Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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16
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Mueller KL, Naganathan S, Griffey RT. Counseling on Access to Lethal Means-Emergency Department (CALM-ED): A Quality Improvement Program for Firearm Injury Prevention. West J Emerg Med 2020; 21:1123-1130. [PMID: 32970565 PMCID: PMC7514406 DOI: 10.5811/westjem.2020.5.46952] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/13/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Suicide is the 10th leading cause of death in the United States, with firearms reported as the cause of death in up to 50% of these cases. Our goal was to evaluate the feasibility of the Counseling on Access to Lethal Means intervention in the Emergency Department (CALM-ED) by non-physician personnel. METHODS We conducted this single-center, prospective, quality improvement study (QI) in an urban, academic ED with over 90,000 annual patient visits. The study looked at adult patients who were discharged after presenting to the ED with suicidal crisis. Assessment of access to lethal means was conducted at the bedside, followed by a counseling session regarding safe storage of lethal means and follow-up via telephone call 48-72 hours after ED discharge. We collected data on patient's sociodemographics, psychiatric history, access to lethal means, lethal means storage methods, the patient's specific plans for lethal means storage after discharge, and post-discharge follow-up care. RESULTS Of 215 eligible patients, 166 voluntarily agreed to participate in CALM-ED, of whom 84 (51%) reported access to lethal means. Following the intervention, 75% of patients described a specific storage plan for their lethal means. Patients with and without access to firearms were equally likely to participate in the follow-up telephone call. CONCLUSION An ED-based CALM QI intervention is feasible for implementation by non-physician personnel and is well received by patients and families. This intervention has the potential to help saves lives at times of suicide crisis.
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Affiliation(s)
- Kristen L Mueller
- Washington University in St. Louis School of Medicine, Department of Emergency Medicine, St. Louis, Missouri
| | - Sonya Naganathan
- Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island
| | - Richard T Griffey
- Washington University in St. Louis School of Medicine, Department of Emergency Medicine, St. Louis, Missouri
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17
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The perspectives of adults with suicidal ideation and behaviour regarding their interactions with nurses in mental health and emergency services: A systematic review. Int J Nurs Stud 2020; 110:103692. [PMID: 32682109 DOI: 10.1016/j.ijnurstu.2020.103692] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/04/2020] [Accepted: 06/14/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND In contemporary healthcare, both community and inpatient mental health and emergency services are important help-seeking avenues for persons with suicidal ideation and behaviour. Regarding nursing practice in these services, there is a strong focus on assessing and managing suicide risk. Within this clinical context, the perspectives of persons with suicidal ideation and behaviour are often overlooked. OBJECTIVE To synthesise the literature examining the perceptions and experiences of persons with suicidal ideation and behaviour regarding their interactions with nurses. DESIGN Review of qualitative and quantitative studies within a data-based convergent synthesis design. DATA SOURCES A systematic search of electronic databases (until January 2020) in PubMed, Web of Science, Embase, and PsycARTICLES. Additional articles were identified through hand searching reference lists. REVIEW METHODS The methodological quality was assessed using the Critical Appraisal Skills Programme for qualitative studies and the QualSyst tool for quantitative studies. Thematic analysis was used to identify the key themes and subthemes. RESULTS In total, 26 studies were selected for analysis. Most studies were qualitative and focused on inpatient mental health services. The studies reflected a spectrum of positive and negative perceptions and experiences of persons with suicidal ideation and behaviour regarding their interactions with nurses. Three key themes were identified: being cared for and acknowledged as a unique individual, giving voice to myself in an atmosphere of connectedness, and encountering a nurturing space to address my suicidality. CONCLUSIONS This systematic review provides insights that can be used to encourage nurses to contribute to suicide prevention and treatment as part of an approach in which they care for, connect, and collaborate with persons experiencing suicidal ideation and behaviour as unique individuals.
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Abstract
PURPOSE OF REVIEW Firearms are a leading cause of death and injury in children, especially in the United States. Many of these injuries present to emergency departments and pediatric ICUs, prompting a need for updated prevention, interventions, and trauma-informed care. This review explores the evidence for prevention and screening for access to firearms, types of injuries, and considerations for mass casualty events. RECENT FINDINGS Firearm-related injuries lead to over 20 000 emergency department visits annually in children and carry a higher risk of severe injury or death. Screening high-risk patients for access to firearms is suboptimal, despite evidence showing reduction in suicide deaths and increased safe storage. While mass casualty shootings represent a low proportion of all firearm-related morbidity, they have brought heightened attention to focus on quality research. SUMMARY Firearm-related injury is a public health crisis and presents a unique risk to children and adolescents. A firearm in the home, especially one with children, significantly increases the risk of death by homicide or suicide. Research on gun violence is leading to important national conversations on gun control and the role of physicians in the prevention of injury and advocacy for effective interventions and legislation.
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19
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Points of Influence for Lethal Means Counseling and Safe Gun Storage Practices. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25:86-89. [PMID: 29889177 DOI: 10.1097/phh.0000000000000801] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Wilson MP, Moutier C, Wolf L, Nordstrom K, Schulz T, Betz ME. ED recommendations for suicide prevention in adults: The ICAR2E mnemonic and a systematic review of the literature. Am J Emerg Med 2020; 38:571-581. [DOI: 10.1016/j.ajem.2019.06.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 01/28/2023] Open
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21
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Strong MA, Schmitz S, Fiedorowicz JG. Improving Psychiatry Resident Knowledge and Reported Practices Regarding Patient Access to Medications and Safe Disposal. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2019; 43:631-634. [PMID: 31407229 DOI: 10.1007/s40596-019-01096-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/02/2019] [Accepted: 07/28/2019] [Indexed: 06/10/2023]
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22
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Bulger EM, Kuhls DA, Campbell BT, Bonne S, Cunningham RM, Betz M, Dicker R, Ranney ML, Barsotti C, Hargarten S, Sakran JV, Rivara FP, James T, Lamis D, Timmerman G, Rogers SO, Choucair B, Stewart RM. Proceedings from the Medical Summit on Firearm Injury Prevention: A Public Health Approach to Reduce Death and Disability in the US. J Am Coll Surg 2019; 229:415-430.e12. [PMID: 31108194 DOI: 10.1016/j.jamcollsurg.2019.05.018] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Eileen M Bulger
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of Washington, Seattle, WA.
| | - Deborah A Kuhls
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of Nevada, Las Vegas, NV
| | - Brendan T Campbell
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of Connecticut, Hartford, CT
| | - Stephanie Bonne
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | | | - Marian Betz
- Department of Emergency Medicine, University of Colorado, Denver, CO
| | - Rochelle Dicker
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of California-Los Angeles, Los Angeles, CA
| | - Megan L Ranney
- Department of Emergency Medicine, Brown University, Alpert Medical School, Providence, RI
| | - Chris Barsotti
- Department of Emergency Medicine, Berkshire Medical Center, Pittsfield, MA
| | - Stephen Hargarten
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Joseph V Sakran
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, Johns Hopkins University, Baltimore, MD
| | | | - Thea James
- Department of Emergency Medicine, Boston University School of Medicine, Boston, MA
| | - Dorian Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Gary Timmerman
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of South Dakota Sanford School of Medicine, Sioux Falls, SD
| | - Selwyn O Rogers
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of Chicago, Chicago, IL
| | | | - Ronald M Stewart
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of Texas San Antonio, San Antonio, TX
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23
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Tung GJ, Pierpoint LA, Betz ME, Brooks-Russell A, Brandspigel S, Runyan CW. Gun Retailers' Willingness to Provide Gun Storage for Suicide Prevention. Am J Health Behav 2019; 43:15-22. [PMID: 30522563 PMCID: PMC10979470 DOI: 10.5993/ajhb.43.1.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: We examined factors grounded in the theory of planned behavior that influence gun retailers' willingness to provide temporary, voluntary firearm storage for suicide prevention. Methods: We conducted a cross-sectional survey of gun retailers in the US mountain west. Analyses included descriptive statistics and ordered logistic regression. Results: Ninety-five gun retailers responded to the survey (25% response rate) and 67.6% (95% CI: 59.6, 75.6) stated that they would be very or somewhat likely to provide temporary gun storage. Firearm retailers who agreed with the statements: "Our store can be an important part of the effort to improve gun safety in my community" (OR: 1.86, 95% CI: 1.1, 3.14) and that offering storage provided "The chance to be seen as a positive member of the community" (OR: 1.49, 95% CI: 1.00, 2.22) were more likely to state that they would be willing to provide storage. Conclusions: Firearm retailers are potentially important storage partners for means safety and suicide prevention efforts. Additional research and practice innovations are needed to assess gun retailers' willingness to provide gun storage and partner on suicide prevention efforts in other geographic regions.
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Affiliation(s)
- Gregory J Tung
- Assistant Professor, Colorado School of Public Health, Department of Health Systems, Management & Policy, Aurora, CO;,
| | - Lauren A Pierpoint
- Doctoral Candidate, Colorado School of Public Health, Department of Epidemiology, Aurora, CO
| | - Marian E Betz
- Associate Professor, University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, CO
| | - Ashley Brooks-Russell
- Assistant Professor, Colorado School of Public Health, Department of Community and Behavioral Health, Aurora, CO
| | - Sara Brandspigel
- Research Instructor, Colorado School of Public Health, Department of Epidemiology, Aurora, CO
| | - Carol W Runyan
- Professor, Colorado School of Public Health, Department of Epidemiology, Aurora, CO
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24
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Betz ME, Knoepke CE, Siry B, Clement A, Azrael D, Ernestus S, Matlock DD. 'Lock to Live': development of a firearm storage decision aid to enhance lethal means counselling and prevent suicide. Inj Prev 2018; 25:i18-i24. [PMID: 30317220 DOI: 10.1136/injuryprev-2018-042944] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to (1) clarify decision needs among suicidal adults with home firearm access; (2) identify accurate, unbiased and acceptable approaches for content and messaging; and (3) develop a tablet-delivered decision aid for firearm storage options. METHODS Following international standards, we used stakeholder interviews to develop a decision aid for the decision, 'what option(s) to choose to reduce home access to firearms for an adult at risk of suicide'. Participants were adults with personal or family history of suicidal ideation or behaviours, firearm ownership or employment in a firearm range or store, involvement in suicide prevention field, or work as emergency department or other healthcare provider. RESULTS Through 64 interviews, we created the 'Lock to Live' decision aid, which includes (1) introduction specifying the decision, (2) clarification of preferences and logistics, (3) table of storage options and (4) summary with specific next steps. The final tool had high user acceptability. CONCLUSIONS Should the 'Lock to Live' decision aid prove useful in a pilot feasibility trial and subsequent testing, it could enhance lethal means counselling and help prevent firearm suicide.
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Affiliation(s)
- Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Christopher E Knoepke
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Bonnie Siry
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ashley Clement
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Deborah Azrael
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Stephanie Ernestus
- Department of Psychiatry, University of California Los Angeles, Los Angeles, California, USA
| | - Daniel D Matlock
- Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
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25
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Betz ME, Brooks-Russell A, Brandspigel S, Novins DK, Tung GJ, Runyan C. Counseling Suicidal Patients About Access to Lethal Means: Attitudes of Emergency Nurse Leaders. J Emerg Nurs 2018; 44:499-504. [PMID: 29704978 PMCID: PMC6150796 DOI: 10.1016/j.jen.2018.03.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION For ED patients at risk of suicide, counseling to reduce access to lethal means (including firearms) is recommended yet not routine. To enhance practice uptake, we sought to examine the attitudes and beliefs of emergency nurse leaders concerning the acceptability and effectiveness of lethal-means counseling. METHODS We invited a nurse leader (ED nurse manager or Chief Nursing Officer [CNO]) at each hospital-based emergency department in the 8-state Mountain West region of the United States to complete a closed-ended telephone survey. Questions assessed current practices and leaders' views on suicide prevention and lethal-means counseling. Reponses were weighted to all eligible hospitals to adjust for nonresponse. RESULTS From 363 eligible hospitals, 190 emergency nurse leaders responded (overall response rate: 52%). Emergency nurse leaders thought providers at their emergency departments did an excellent job of safety counseling (74%) for suicidal patients. Most respondents believed that talking about firearms with suicidal patients is acceptable to patients (77%), supported by hospital administration (64%), effective in preventing suicide (69%), and something that providers should do (91%). However, the majority also had doubts about whether suicide is preventable (60%). DISCUSSION Despite expressing high levels of support for the acceptability and effectiveness of lethal-means counseling, high proportions of emergency nurse leaders expressed skepticism regarding the preventability of suicide, a finding consistent with previous work. Our results support the need to address and modify misperceptions about prevention of suicide in any efforts for widespread implementation and dissemination of lethal-means counseling.
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26
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Frequency of lethal means assessment among emergency department patients with a positive suicide risk screen. Psychiatry Res 2018; 260:30-35. [PMID: 29169036 PMCID: PMC5951732 DOI: 10.1016/j.psychres.2017.11.038] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 11/11/2017] [Accepted: 11/12/2017] [Indexed: 11/21/2022]
Abstract
Prior work from surveys and limited populations suggests many emergency department (ED) patients with suicide risk do not have documented lethal means assessments (e.g., being asked about home firearms). The specific objectives of this study were to, in an ED with universal screening for suicide risk: (1) estimate how often ED providers documented lethal means assessment for suicidal patients, and (2) compare patients with and without documented lethal means assessments. We reviewed 800 total charts from a random sample of adults in three a priori age groups (18-34 years; 35-59 years; ≥ 60 years) with a positive suicide risk screen from 8/2014 to 12/2015. Only 18% (n = 145) had documentation by ≥ 1 provider of assessment of lethal means access. Among these 145, only 8% (n = 11) had documentation that someone discussed an action plan to reduce access (most commonly changing home storage or moving objects out of the home). Among 545 suicidal patients discharged home from the ED, 85% had no documentation that any provider assessed access to lethal means. Our findings highlight an important area for improving care: routine, documented lethal means assessment and counseling for patients with suicide risk. There is an urgent need for further exploration of barriers and facilitators.
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