Encouraging Firearm Access Disclosure: Suicide Prevention in Health Care

Firearms are the most common means of suicide death in the U.S.  Access to firearms is linked to increased suicide risk among adolescents and adults.  Clinical suicide practices, like lethal means assessment and safety planning, are associated with reduced risk of suicide.  Healthcare providers may have valuable opportunities to intervene with patients at risk of suicide, because most adolescents and adults who die by suicide see a provider in the months leading up to their death.  Moreover, we recently demonstrated that patients will answer standard questions about firearm access, which may aid identification and engagement of patients at high risk of firearm suicide.  However, we also found that among a population of patients who died by firearm suicide, more than half reported no firearm access in the year prior to death.  Our qualitative analyses (past and current) underscore patients perceived barriers to reporting firearm access, including anticipated stigma and discrimination, as well as important suggestions and considerations for improving the patient-centeredness of this practice.  Therefore, the purpose of this 2-year project will be to encourage patients to self-report firearm access by using Human-Centered Design methodology, which will draw on lived experiences of individuals with profession and lived experiences with suicidality, as well as evidence from our prior statistical and qualitative analyses, to improve the patient-centeredness of standardized firearm access questions.  The specific aims of this project are to:

1) Measure response to a firearm access question on standardized mental health questionnaires among adolescents and adults in primary care and specialty mental health in both virtual and in-person settings, augmenting prior findings from adult in-person encounters.

2) Apply Human-Centered Design methods to iteratively design and improve the questionnaire introduction (e.g., instructions, orientation language) and clinician follow-up guidance, with the goal of encouraging firearm access disclosure, and dialogue to support limiting access for suicide prevention.

3) Pilot revised firearm question content and supporting resources in one or more clinics and compare patient response pre and post pilot implementation. We hypothesize the revised questionnaire content will positively impact response to standard firearm access, specifically higher rates of response and firearm access disclosure.

Potential Impact: Kaiser Permanente health systems are responsible for 12.5 million lives nationwide and leaders are committed to suicide prevention. Therefore, the results of this project have the potential to improve the patient-centeredness of this practice for millions of patients nationwide.  This project will also create opportunities for large-scale research trials examining effectiveness of patient-reported firearm access for identification of patients at risk of suicide, engagement in safety planning interventions, as well as prevention of suicide deaths.