Firearms are a highly lethal method of suicide attempt and the most common method of suicide death in the U.S. While suicide accounts for 60 percent of all U.S. firearm deaths, and 80 percent in Washington state, researchers are hoping to change that with the help of health care providers.
Julie E. Richards, a PhD candidate with the Department of Health Services in the University of Washington School of Public Health, will lead a team in evaluating how clinicians could help prevent some suicides by asking patients about their access to firearms when they are receiving mental health-related care.
Saving lives drives Richards’ personal and professional beliefs in the importance of suicide prevention research. “We, as individuals and members of the medical community, have an important opportunity,” she said.
Health care providers are in a unique position to intervene with patients at risk for firearm suicide death. About 50 percent of individuals who die by suicide see a health care provider in the month before death and more than 80 percent see a provider the year before death. However, providers in most health systems do not ask patients about firearms, and there are no clinical guidelines to address this topic.
“Firearm-related research has been underfunded for the past couple decades, so this is a really big opportunity for us to collaborate on a line of research that is important to all of us,” she said. “Those opportunities don’t come along every day, and my research team and I are very grateful.”
With about $400,000 in funding for two years from Kaiser Permanente (KP), Richards and her team will use existing data to explore the relationship between responses to screening questions with KP Washington and subsequent firearm injury events. Researchers will complement this data with interviews to assess the acceptability of the questions for patients. In parallel, clinicians will offer patients an anonymous, web-based decision aid for safe firearm storage. Richards and her team will examine the utility of this new decision aid for clinicians and the extent to which the aid is used by patients at risk of suicide.
“Limited funding for firearm injury research during the past 20 years has left numerous crucial questions unanswered when it comes to mental health and suicide prevention,” said Ali Rowhani-Rahbar, co-investigator and associate professor with the Department of Epidemiology in the UW School of Public Health. “With the terrific data infrastructure of KP, along with their commitment to research, we can produce evidence-informed policies and practices to save lives at the critical intersection of two major public health concerns — firearm injury and suicide.”
Access to firearms, especially if stored loaded and unlocked, is linked to increase suicide risk. And, Richards and her team know that reducing that risk can have a ripple effect on population health. “Preventing suicide and saving lives also means preventing suffering of those who will experience the loss of valuable family and community members who die by suicide,” Richards said. “I believe there are individuals who may take action to end their lives today, but might not take that same action tomorrow if their circumstances change. Those circumstances may include easy access to a firearm, which is highly lethal, resulting in death 85 to 95 percent of the time.”
This research project is one of three clinical research studies that focus on how clinicians can help prevent firearm injuries — including suicide, intimate partner violence and accidents — as part of KP’s pledge to invest $2 million to prevent gun injuries and deaths.
Richards is also a research associate with the KP Washington Health Research Institute. Co-investigators for the project include Ursula Whiteside (psychologist at UW Department of Psychiatry), Jennifer Bobb (biostatistician at the KP Washington Health Research Institute), Maggie Jones (director of the Center for Community Health and Evaluation at KP Washington), Elena Kuo (researcher at the Center for Community Health and Evaluation at KP Washington), Marian Betz (associate professor of Emergency Medicine at the University of Colorado School of Medicine), and mentor Greg Simon (research professor at UW Department of Psychiatry and Behavioral Sciences). Rebecca Parrish, mental health clinical consultant and social work manager, is the clinical champion at KP Washington.