Political Beliefs, Region of Residence, and Openness to Firearm Means Safety Measures to Prevent Suicide

Emergency medical services (EMS) clinicians' views on EMS-delivered interventions to promote secure firearm storage practices

INTRODUCTION

Lethal means safety counseling (LMSC) to promote secure firearm storage may reduce the risk of firearm-involved deaths, including suicide. We examined if emergency medical services (EMS) clinicians, including emergency medical technicians and paramedics, may be suitable LMSC messengers.

METHOD

We conducted a web-based survey of 229 US EMS clinicians.

RESULTS

While few EMS clinicians supported EMS-delivered LMSC to all patients (17.0%), most supported EMS-delivered LMSC to patients in an acute suicidal crisis (64.2%) or with a known suicide attempt history (55.9%). Barriers to EMS-delivered LMSC included lack of training (73.4%), perceptions that LMSC is outside EMS clinicians' scope of practice (58.1%), and lack of standard operating procedures (56.3%). Most reported at least some interest in receiving training on EMS-delivered LMSC (67.7%). Participants holding more accurate beliefs about the link between firearm storage practices and suicide risk, as well as the efficacy of LMSC, were more likely to support EMS-delivered LMSC across patient scenarios (ORs = 2.18-5.21, ps <0.01) and express interest in receiving LMSC training (ORs = 3.78-5.43, ps <0.001).

CONCLUSION

Given that many EMS clinicians interface with patients at elevated suicide risk, targeted LMSC training may be strategic; however, research is needed to determine if and how EMS clinicians might be viable LMSC messengers.

Bystander intervention to prevent firearm injury: A qualitative study of 4-H shooting sports participants

This qualitative study examines how youth and adult members of 4-H Shooting Sports clubs perceive firearm injury risk and risk reduction, and the applicability of a bystander intervention (BI) risk reduction framework in this community. Semistructured interviews were conducted with 11 youth and 13 adult members of 4-H Shooting Sports clubs across nine US states from March to December of 2021 until thematic saturation was reached. Deductive and inductive thematic qualitative analyses were performed. Six overarching themes emerged: (1) The tendency to view firearm injury as predominantly unintentional in nature; (2) Acknowledgment of a wide array of risks for firearm injury; (3) Perceived barriers to bystander action to prevent firearm injury including knowledge, confidence, and consequences of action; (4) Facilitators of bystander action including a sense of civic responsibility; (5) Direct and indirect strategies to address potential risks for firearm injury; and (6) Belief that BI skills training would be useful for 4-H Shooting Sports. Findings lay the groundwork for applying BI skills training as an approach to firearm injury prevention in 4-H Shooting Sports, similar to how BI has been applied to other types of injury (i.e., sexual assault). 4-H Shooting Sports club members' sense of civic responsibility is a key facilitator. Prevention efforts should attend to the broad array of ways in which firearm injury occurs, including suicide, mass shootings, homicide, and intimate partner violence, as well as unintentional injury.

Lethal Means Counseling for Suicidal Firearm Owners

The death of a patient by suicide is one of the professional events most feared by psychotherapists and firearms are the most commonly used means of suicide. However, as the number of firearm owners within the United States has increased in recent years, so has the risk of firearm-related suicides. Suicidal patients with easy access to their firearms may give in to the wish to die and end their life with little opportunity for reflection or forethought. Furthermore, because the topic of gun control has become so polarized, patients may not always be open to discussing barriers between themselves and their firearms. Nonetheless, psychotherapists using non-judgmental, respectful, and collaborative lethal means counseling can substantially reduce patient suicides.

Always at the Ready: Fears, Threats, and Unsafe Gun Storage in Households With Children

Guns are present in many households in the U.S., including those with children. Safe storage of guns at home can mitigate the increased risks of both the unintentional and intentional injury that in-home gun access presents; yet estimates suggest fewer than half of gun owners store their weapon(s) safely. Unsafe storage in homes with children is especially problematic given that gun-owning parents make incorrect assumptions about both children's awareness of firearm storage locations, and their actions upon encountering an unsecured gun. There is limited identification and understanding of why some parents do not engage in safe storage practices. Using 2019 survey data from an internet-based sample of gun-owning adults with children at home, this study explores various potential correlates of unsafe storage. Findings suggest that unsafe storage occurs not in response to crime/victimization fears, but from broader, group- and status-based threats. Understanding the complex factors preventing gun-owning parents from implementing safe storage practices has important implications for both victimization scholarship and public health/injury prevention efforts.

Achieving health equity in US suicides: a narrative review and commentary

Suicide rates in the United States (US) reached a peak in 2018 and declined in 2019 and 2020, with substantial and often growing disparities by age, sex, race/ethnicity, geography, veteran status, sexual minority status, socioeconomic status, and method employed (means disparity). In this narrative review and commentary, we highlight these many disparities in US suicide deaths, then examine the possible causes and potential solutions, with the overarching goal of reducing suicide death disparities to achieve health equity.The data implicate untreated, undertreated, or unidentified depression or other mental illness, and access to firearms, as two modifiable risk factors for suicide across all groups. The data also reveal firearm suicides increasing sharply and linearly with increasing county rurality, while suicide rates by falls (e.g., from tall structures) decrease linearly by increasing rurality, and suicide rates by other means remain fairly constant regardless of relative county urbanization. In addition, for all geographies, gun suicides are significantly higher in males than females, and highest in ages 51-85 + years old for both sexes. Of all US suicides from 1999-2019, 55% of male suicides and 29% of female suicides were by gun in metropolitan (metro) areas, versus 65% (Male) and 42% (Female) suicides by gun in non-metro areas. Guns accounted for 89% of suicides in non-metro males aged 71-85 + years old. Guns (i.e., employment of more lethal means) are also thought to be a major reason why males have, on average, 2-4 times higher suicide rates than women, despite having only 1/4-1/2 as many suicide attempts as women. Overall the literature and data strongly implicate firearm access as a risk factor for suicide across all populations, and even more so for male, rural, and older populations.To achieve the most significant results in suicide prevention across all groups, we need 1) more emphasis on policies and universal programs to reduce suicidal behaviors, and 2) enhanced population-based strategies for ameliorating the two most prominent modifiable targets for suicide prevention: depression and firearms.

On prediction, refutation, and explanatory reach: A consideration of the Interpersonal Theory of Suicidal Behavior

Theory proposition, empirical evaluation, and resulting support or refutation are core pieces of the scientific process. These steps of theory-testing, however, can be complicated by relative rigidity and dogmatism, in combination with the logistical challenges inherent in conducting comprehensive, real-world tests of theories explicating complex scientific phenomena, especially rare ones. It may be argued that suicide is one such phenomenon, and one for which the field of psychology has struggled to develop satisfactory understanding. One leading theory of suicide, the Interpersonal Theory of Suicide, has garnered attention and, to a considerable degree, has weathered substantial scrutiny. Still, it is arguable that the theory has yet to be tested in full-that is, in accordance with all propositions originally put forth. In this effort, we sought to evaluate the current state of knowledge regarding the Interpersonal Theory of Suicide, as well as to suggest potential directions via which future work may proceed. We draw from the fields of philosophy, psychology, physics, and engineering in the hopes of engendering curiosity and critical thought about the assumptions researchers (ourselves included) bring to their work. We direct particular attention to the role of refutation in theory-testing; the supposed dichotomy of explanatory vs. algorithmic approaches; and the categorization of research programs as progressive vs. degenerative. In doing so, we hope not only to promote these ideas in the study of suicidal behavior but also to empiricists of all creeds and foci. We also include implications for suicide prevention efforts.

The Role of Reason for Firearm Ownership in Beliefs about Firearms and Suicide, Openness to Means Safety, and Current Firearm Storage

OBJECTIVE

Firearm means safety strategies, such as safe storage, are effective in reducing suicide rates but are not widely implemented in the United States. This study examined the association between reason for firearm ownership, beliefs about firearm ownership and storage and suicide risk, willingness to engage in means safety, and current firearm storage practices.

METHOD

A sample of 300 American firearm owners (53.0% male; 82.3% White; M_age  = 36.11, age range = 20-69) completed an online survey via Amazon's Mechanical Turk (mTurk) program.

RESULTS

Firearm owners who own a firearm for protection, compared to owning a firearm for other reasons, (1) endorsed decreased belief in the relationship between firearm ownership and storage and suicide risk, (2) were less willing to engage in the means safety measures of storing firearms safely and allowing a trusted individual to temporarily remove firearms from the home, and (3) were more likely to store their firearms loaded.

CONCLUSIONS

Reason for firearm ownership influences views regarding firearms and suicide, willingness to engage in firearm means safety, and firearm storage practices. It is essential to understand how differences in reason for firearm ownership impact these outcomes so appropriate, efficacious messaging can be developed and implemented.

Openness to firearm storage safety as a suicide prevention tool among those exposed to suicide: The role of perceived closeness to the suicide decedent

BACKGROUND

Exposure to suicide and closeness to a suicide decedent may be relevant to means safety, especially in firearm owners. This study examines how such factors are associated with firearm owners' current firearm storage methods and openness to changing storage methods.

METHOD

300 firearm owners completed a survey on Amazon's Mechanical Turk program; 176 participants reported being exposed to suicide. Perceived closeness was rated as Not at all close, Close, or Extremely Close.

RESULTS

Those exposed to suicide were more open to secure storage and temporarily storing the firearm with a trusted individual to prevent someone else's suicide. Those close to the suicide decedent were more likely to use secure storage practices, more open to using secure storage methods to prevent their own and someone else's suicide, and had a higher degree of storage methods in place compared to those not close to the decedent.

LIMITATIONS

The sample may not be representative of all American firearm owners exposed to suicide.

CONCLUSIONS

Being close to a suicide decedent may influence firearm owners' current storage practices and openness to changing storage methods. Such individuals may better relate to the suicide decedent and realize the significance of using secure storage methods to prevent suicide.