title: Lethal means restriction for suicide prevention: beliefs and behaviors of emergency department providers.
abstract: BACKGROUND
  We sought to examine the beliefs and behaviors of emergency department (ED) providers related to preventing suicide by reducing suicidal patients' access to lethal methods (means restriction) and identify characteristics associated with asking patients about firearm access.
  
  
  METHODS
  Physicians and nurses at eight EDs completed a confidential, voluntary survey.
  
  
  RESULTS
  The response rate was 79% (n = 631); 57% of respondents were females and 49% were nurses. Less than half believed, "most" or "all" suicides are preventable. More nurses (67%) than physicians (44%) thought "most" or "all" firearm suicide decedents would have died by another method had a firearm been unavailable (P < .001). The proportion of providers who reported they "almost always" ask suicidal patients about firearm access varied across five patient scenarios: suicidal with firearm suicide plan (64%), suicidal with no suicide plan (22%), suicidal with nonfirearm plan (21%), suicidal in past month but not today (16%), and overdosed but no longer suicidal (9%). In multivariable logistic regression, physicians were more likely than nurses to "almost always" or "often" ask about a firearm across all five scenarios, as were older providers and those who believed their own provider type was responsible for assessing firearm access.
  
  
  CONCLUSIONS
  Many ED providers are skeptical about the preventability of suicide and the effectiveness of means restriction, and most do not assess suicidal patients' firearm access except when a patient has a firearm suicide plan. These findings suggest the need for targeted staff education concerning means restriction for suicide prevention.
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado.
authors.forename: Marian E
authors.initials: ME
authors.lastname: Betz
authors.forename: Matthew
authors.initials: M
authors.lastname: Miller
authors.forename: Catherine
authors.initials: C
authors.lastname: Barber
authors.forename: Ivan
authors.initials: I
authors.lastname: Miller
authors.forename: Ashley F
authors.initials: AF
authors.lastname: Sullivan
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.forename: Edwin D
authors.initials: ED
authors.lastname: Boudreaux
mesh_terms: D000328:Adult; D000368:Aged; D003469:Culture; D003625:Data Collection; D037001:Directive Counseling / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D005389:Firearms / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000706:statistics & numerical data; D010820:Physicians / Q000706:statistics & numerical data; D059020:Suicidal Ideation; D013405:Suicide / Q000706:statistics & numerical data; D013406:Suicide, Attempted / Q000517:prevention & control* / Q000706:statistics & numerical data; D000092864:Suicide Prevention
keywords: attitudes; emergency psychiatry; firearm; hospital care; screening