How PCPs can help prevent firearm-related suicide

Key takeaways:

• More than 24,000 people died by firearm-related suicide in 2020, but discussions about gun safety with patients can be difficult.
• A presenter here offered tips for physicians navigating these conversations.

SAN DIEGO — Primary care physicians play an important role in preventing suicide using firearms, according to a presenter at the ACP Internal Medicine Meeting.

Suicide is responsible for the most deaths from firearm injuries in the United States each year, Erik Wallace, MD, FACP, a clinical professor at the University of Colorado School of Medicine and senior medical director for Colorado, Oak Street Health, said in his presentation.

Although recent data from the CDC showed that 24,292 people in the U.S. died by firearm-related suicide in 2020, community discussions about the relationship between firearms and suicide can often drum up myths that are “contrary to the data that we know,” he said.

For example, data have clearly indicated that, rather than confer protection, a gun in the home is associated with both an increase in homicide risk and suicide risk, but this is not a popularly held belief, Wallace said. In a survey assessing whether people think having a gun in the home increases the risk for suicide, just 15.4% said “yes.”

“A lot of people who own a firearm, own a firearm for protection,” he said. “And if you're owning a firearm for protection, you have the belief that that is keeping you and your family safe, and you're not necessarily thinking about all of the potential risks associated with that.”

The most prevalent myth, Wallace said, is that people who want to die by suicide are going to do so, even if they do not have access to a gun.

“This is the Displacement Theory, meaning if you're thinking about suicide and you don't have access to a particular lethal mean, you're simply going to choose something else,” he said. “And we know that's actually not true.”

Although the situation seems bleak, Wallace noted that up to 45% of people who died by suicide saw their PCP within a month of doing so, presenting an opportunity for intervention. However, clinicians may face challenges in speaking with their patients about firearm injury prevention.

Providers “often have fear and discomfort around discussing ‘political topics,’” Wallace said. Although he “would argue strongly that firearm safety should not be a political topic,” it is undeniable that bringing up firearms in the U.S. today “instantly draws up feelings around politics — and pretty strong feelings” that can keep physicians from having these conversations.

Clinicians also fear damaging the physician-patient relationship over “this very sensitive topic,” Wallace said.

“We have a lot of sensitive questions that we have with our patients. We talk about sex, drugs, and that doesn't seem to bother us as much, but ... we received practice and training and education on how to have those conversations,” he said.

Wallace highlighted some resources and general tips that can help physicians navigate these tricky conversations. A website developed at the University of California, Davis, for example, provides various clinical scenarios and other resources designed for clinicians.

Additionally, he encouraged providers to think of firearm counseling as a cultural competence, adopting respectful counseling behaviors that are individualized to the patient and routine for certain high-risk populations.”

“Provide nonjudgmental firearm safety information empathetically without explicit orders to do something ... and provide a range of options so that patients can make a choice,” he said. “The language that you use matters.”