In the United States, more people die by self-inflicted
gunshot than by all other suicide methods combined (Miller, Azrael, & Hemenway,
2002). Whether or not a patient has access to a firearm can determine
the outcome of a suicidal crisis. Deficient clinical screening
for firearm access increases the risk of suicide completion (Kaplan,
Adamek, & Rhodes, 1998).
article briefly summarizes the results of a recent investigation
of psychologists’ firearm
assessment practices. Eight hundred members of the APA Practice
Directorate were surveyed regarding suicide risk assessment
practices, experience with suicidal patients, and personal firearm
history. The usable response rate was 51.9% (N=415).
The mean age
of respondents was 53.4 years (SD=8.6) and the mean years of
postdoctoral experience was 18.6 (SD=8.4). Of the valid respondents,
49.2% were male and 50.8% were female. Almost all respondents held
a Ph.D. (79%), or a Psy.D. (19%). Over 65% indicated Private Practice
as their Primary Employment Setting. Overall, 78% indicated Private
Practice as either their Primary or Secondary Employment Setting.
Almost 80% of the respondents indicated that they perform more
than half of their clinical work with adult patients.
Ownership among Psychologists
Current firearm ownership was reported by 19.5% (n=81) of the
psychologists participating in this study. Nearly 30% of respondents
reported that they had owned a firearm at some point in their
life. Male respondents were far more likely than female respondents
to own firearms (Male=30%; Female=9%). In addition to the psychologists
who personally own firearms, 7.2% of non-owners indicated that
firearms were present in their households. Therefore, firearms
were present in 26.7% of the homes in this sample. The rate of
household firearm ownership for psychologists in this study was
only slightly lower than national estimates of household firearm
access. The 19.5% firearm ownership rate among psychologists was
much lower than the 32% rate found in a survey of psychiatrists
More than one-fifth
of the firearm-owning psychologists in this study reported sometimes
carrying a concealed firearm. Approximately 12% of the firearm-owning
psychologists reported keeping a firearm in their office. While
almost two-thirds of respondents indicated that they had personally
discharged a firearm at least once, nearly one-fourth of respondents
indicated that they had never before handled or touched a firearm.
Compared to non-owners,
firearm owners were more likely to be male, to live in a rural
area, and to reside in a Southern state. There were no differences
between owners and non-owners with regard to age, race/ethnicity,
marital status, or whether children under the age of 18 were living
in the home. Handguns were the most commonly owned firearm (69%
of owners), followed by rifles (58%), and shotguns (56%). Most
firearm owners (80%) owned more than one type of firearm. Among
firearm owning psychologists, the mean number of firearms owned
was 3.9, with a range of 1 to 26.
male respondents indicated recreation (i.e. hunting, target shooting,
or collecting) as their primary reason for firearm ownership,
whereas most female respondents indicated self-defense. A remarkable
22% of respondents indicated “Other” as
their Primary Reason for Firearm Ownership. This suggests that
firearms are likely to be present in the homes of many people
who have no readily apparent reason to own them.
On average, clinicians who currently own firearms (or who
had owned them in past) directly inquired about firearm access
with firearms from their homes (M=24.8; SD=56.5) as did non-owning
clinicians (M=8.3; SD=13.55). With regard to the perceived efficacy
of these interventions, firearm owners reported a 70% success
rate, compared to 66% reported by non-owners.
The base rate for patient firearm ownership estimated by current
or former firearm owners (M=24.1%; SD=22.3) was almost
twice as high as the estimate by non-owners (M=12.5%; SD=16.9).
The estimate of patient household firearm access by firearm-owners
(M=33.5%; SD=26.5) was nearly 67% greater than the estimate by
non-owners (M=20.1%; SD=21.4). Published rates of firearm ownership
in clinical populations range from 27.9% in a sample of older adults receiving
primary care treatment (Oslin et al., 2004) to 60.4% in
families of patients diagnosed with dementia (Spangenberg, Wagner,
Hendrix, & Bachman, 1999).
More than half of respondents (n=230; 55.4%) reported inquiring
directly about current suicidal ideation during the first session
with all of their last 10 patients. However, 20.7% (n=86) reported
performing this basic suicide risk assessment with fewer than half
of their last 10 patients. Almost 3% (n=11) reported that they
did not assess for current suicidal ideation during the first session
with any of their last 10 patients. Clinicians who were less likely
to inquire about suicidal ideation tended to be more experienced,
to have never lost a patient to suicide, and to be in private practice.
Current or former firearm owners reported inquiring about current
suicidal ideation and past suicide attempts more frequently than
More than half
of respondents (n=217; 52.3%) reported inquiring directly about
past suicide attempts with all of their last 10 patients. However,
22.2% (n=92) reported that they had inquired about past suicide
attempts with fewer than half of their last 10 patients. Almost
5% (n=19) reported that they had asked none of their last 10 patients
about past suicide attempts.
More than half
of respondents (n=216; 52.0%) reported assessing family history of suicide
with all of their last 10 patients. However, 24.1% (n=100) reported that
they had assessed family suicide history with fewer than half of their
last 10 patients. Over 8% (n=34) reported that they had asked none
of their last 10 patients about family suicide history.
of Suicidal Patients
In a typical month, the average respondent reported treating
5.4 patients “for whom suicide is an issue” (SD=5.2;
Mode=2; Median=4.0). Only 5.1% of respondents reported seeing
no patients in a typical month for whom suicide is an issue.
In fact, 43.9% of respondents reported treating five or more
such patients each month. A majority of clinicians (n=237;
57.1%) reported having treated 15 or more patients who required
voluntary or involuntary hospitalization. Only 3.4% (n=27)
reported never having treated a patient who required voluntary
or involuntary hospitalization.
majority (n=388; 93.5%) of the psychologists in this study reported
that at least one patient under their care had attempted suicide.
Nearly 36% (n=148) reported having lost a patient
under their care to suicide. Over 34% (n=142) reported
that a patient under their care had attempted suicide
with a firearm. Almost 15% (n=62) reported having lost a patient
under their care to suicide-by-firearm.
Eighty percent of the psychologists participating in this study
agreed that the presence of a firearm is a major
risk factor for completed suicide. Over two-thirds of respondents
considered themselves competent to discuss firearms with
their patients. Almost 60% of respondents agreed that additional
laws restricting access to firearms could reduce suicide
rates. Almost half agreed that psychologists have a duty
to counsel patients regarding safe firearm storage practices.
32% of respondents agreed that psychologists should assess for
firearm access with all of their patients, and just 22% agreed
that psychologists should counsel patients to remove firearms from
their homes. Only 17% agreed that psychologists have a duty to
report violations of firearms laws.
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Kaplan, M.S., Adamek, M.E., & Rhoades, J.A. (1998). Prevention
of elderly suicide: Physicians’ assessment of firearm availability.
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Azrael, D., & Hemenway, D. (2002). Household firearm
ownership and suicide rates in the United States. Epidemiology,
Oslin, D.W., Zubritsky, C., Brown, G., Mullahy,
M., Puliafico, & Ten
Have, T. (2004). Managing suicide risk in late life: Access to
firearms as a public health risk. American
Journal of Geriatric Psychiatry, 12(1), 30-36.
Spangenberg, K.B., Wagner, M.T., Hendrix,
S., & Bachman, D.L.
(1999). Firearm presence in households of patients with Alzheimer’s
disease and dementia. Journal of the American
Geriatric Society, 47, 1183-1186.