Use of lethal means restriction counseling for suicide prevention in pediatric primary care

Bandealy, Asad; Herrera, Nicole; Weissman, Mark; Scheidt, Peter

doi:10.1016/j.ypmed.2019.105855

Cited by 25Suicide and Self-Harm StudiesGun Ownership and Violence ResearchHomicide, Infanticide, and Child Abuse

Use of lethal means restriction counseling for suicide prevention in pediatric primary care

Bandealy, Asad, Herrera, Nicole, Weissman, Mark, Scheidt, Peter·2020·Preventive Medicine

DOI 10.1016/j.ypmed.2019.105855

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Abstract

Suicide is the second-leading cause of death for adolescents in the United States. Counseling patients and families on safe storage of firearms and medications is an effective method of suicide prevention. We sought to determine the self-reported frequency of lethal means restriction (LMR) counseling among primary care pediatric providers working with adolescents who are at risk for suicide as well as factors associated with consistently employing LMR counseling. An anonymous, self-report, electronic survey was conducted of primary care pediatricians in the Washington, DC metropolitan area of LMR counseling for suicide prevention. The survey was conducted over 10 weeks in autumn of 2017. Stepwise, multivariate logistic models were used to determine factors associated with firearm screening and LMR counseling for patients at risk for suicide. Response rate was 11% (n = 1546). Over a range of suicide risk scenarios, few respondents reported consistently screening for firearms (21.9%) or employing LMR counseling (19.4%). When adjusting for confounding, five or more years in practice was associated with higher odds of screening for firearms (aOR 4.6 [1.3-16]). Previous LMR training was strongly associated with consistent LMR counseling (aOR 8.3 [1.8-38.4]). While LMR counseling can reduce risk for completed suicide, most respondents do not consistently employ it. Those who have received training are more likely to counsel. Thus, LMR counseling should be a standard part of medical education for pediatricians.

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In a survey of pediatric primary care providers, only 19.4% reported consistently screening for firearms or providing lethal means restriction counseling.
“In a survey of pediatric primary care providers, only 19.4% reported consistently screening for firearms or providing lethal means restriction counseling.72”
From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [72]

Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2008.08.010 · Cited by 51,384 · see citing works
Methods to increase response to postal and electronic questionnaires
Edwards, P. J., Roberts, I., Clarke, M. J., DiGuiseppi, C., Wentz, R., Kwan, I., Cooper, R., Felix, L. M., & Pratap, S. (2009) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.mr000008.pub4 · Cited by 1,379 · see citing works
Fatal and non-fatal repetition of self-harm: Systematic review
Owens, D., Horrocks, J., & House, A. (2002) · British Journal of Psychiatry · doi:10.1192/bjp.181.3.193 · Cited by 1,241 · see citing works
Suicide acts in 8 states: incidence and case fatality rates by demographics and method
Spicer, R. S., & Miller, T. R. (2000) · American Journal of Public Health · doi:10.2105/ajph.90.12.1885 · Cited by 491 · see citing works
New data on the nature of suicidal crises in college students: Shifting the paradigm.
Drum, D. J., Brownson, C. B., Denmark, A. B., & Smith, S. E. (2009) · Professional Psychology Research and Practice · doi:10.1037/a0014465 · Cited by 485 · see citing works
Reducing a Suicidal Person’s Access to Lethal Means of Suicide
Barber, C. W., & Miller, M. J. (2014) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2014.05.028 · Cited by 329 · see citing works
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Deisenhammer, E. A., Ing, C.-M., Strauss, R., Kemmler, G., Hinterhuber, H., & Weiss, E. M. (2009) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.07m03904 · Cited by 315 · see citing works
Suicide and violence prevention: Parent education in the emergency department
Kruesi, M. J. P., Grossman, J., Pennington, J. M., Woodward, P. J., Duda, D., & Hirsch, J. G. (1999) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199903000-00010 · Cited by 251 · see citing works
The duration of the suicidal process: how much time is left for intervention between consideration and accomplishment of a suicide attempt?
Deisenhammer, E., Ing, C.-M., Strauss, R., Kemmler, G., Hinterhuber, H., & Weiss, E. M. (2009) · PubMed · Cited by 237 · see citing works
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Lubin, G., Werbeloff, N., Halperin, D., Shmushkevitch, M., Weiser, M., & Knobler, H. Y. (2010) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.2010.40.5.421 · Cited by 159 · see citing works
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Authors: Bandealy, A., Herrera, N., Weissman, M., & Scheidt, P.
Affiliations: Children's National (US)
Corresponding author: Bandealy, Asad
Venue: Preventive Medicine
Publisher: Elsevier BV
Published: 2020-01
Volume: 130
Pages: 105855
ISSN: 0091-7435 (ISSN-L)
DOI: 10.1016/j.ypmed.2019.105855
OpenAlex: W2980752510
Cited by: 25
References: 25
Citations by year: 2026: 4 · 2025: 4 · 2024: 4 · 2023: 4 · 2022: 3 · 2021: 6
FWCI: 2.63
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Preventive Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: Division of General Pediatrics and Community Health
Topics: Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
Social Sciences › Health › Gun Ownership and Violence Research
Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
Keywords: suicide prevention, pediatric primary care, adolescents, drug safety, suicide risk, pediatricians, clinician training, medical education
MeSH terms: Pediatricians, Suicide Prevention, Adult, Counseling, District of Columbia, Female, Firearms, Humans, Male, Middle Aged, Pediatrics, Primary Health Care, Surveys and Questionnaires

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Use of lethal means restriction counseling for suicide prevention in pediatric primary care

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