title: LETHAL MEANS ACCESS AND ASSESSMENT AMONG SUICIDAL EMERGENCY DEPARTMENT PATIENTS.
abstract: Reducing access to lethal means (especially firearms) might prevent suicide, but counseling of at-risk individuals about this strategy may not be routine. Among emergency department (ED) patients with suicidal ideation or attempts (SI/SA), we sought to describe home firearm access and examine ED provider assessment of access to lethal means.
  
  
  
  This secondary analysis used data from the Emergency Department Safety Assessment and Follow-up Evaluation, a three-phase, eight-center study of adult ED patients with SI/SA (2010-2013). Research staff surveyed participants about suicide-related factors (including home firearms) and later reviewed the ED chart (including documented assessment of lethal means access).
  
  
  
  Among 1,358 patients with SI/SA, 11% (95% CI: 10-13%) reported ≥1 firearm at home; rates varied across sites (range: 6-26%) but not over time. On chart review, 50% (95% CI: 47-52%) of patients had documentation of lethal means access assessment. Frequency of documented assessment increased over study phases (40-60%, P < .001) but was not associated with state firearm ownership rates. Among the 337 (25%, 95% CI: 23-27%) patients discharged to home, 55% (95% CI: 49-60%) had no documentation of lethal means assessment; of these, 13% (95% CI: 8-19%; n = 24) actually had ≥1 firearm at home. Among all those reporting ≥1 home firearm to study staff, only half (50%, 95% CI: 42-59%) had provider documentation of assessment of lethal means access.
  
  
  
  Among these ED patients with SI/SA, many did not have documented assessment of home access to lethal means, including patients who were discharged home and had ≥1 firearm at home.
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Marian E
authors.initials: ME
authors.lastname: Betz
authors.affiliation: Harvard Injury Control Research Center, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Matthew
authors.initials: M
authors.lastname: Miller
authors.affiliation: Harvard Injury Control Research Center, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Catherine
authors.initials: C
authors.lastname: Barber
authors.affiliation: Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Brenda
authors.initials: B
authors.lastname: Beaty
authors.affiliation: Butler Hospital, Providence, Rhode Island.
authors.forename: Ivan
authors.initials: I
authors.lastname: Miller
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.affiliation: Departments of Emergency Medicine, Psychiatry, and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Edwin D
authors.initials: ED
authors.lastname: Boudreaux
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005389:Firearms / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D014481:United States
keywords: assessment/diagnosis; clinical trials; depression; epidemiology; suicide/self-harm; treatment