Doctors Could Play a Part in Preventing Suicides
WEDNESDAY Sept. 3, 2008 -- Physicians could dramatically reduce the number of suicides by restricting at-risk patients' access to guns and other highly lethal ways of killing themselves, say Harvard School of Public Health researchers.
"The temporary nature and fleeting sway of many suicidal crises is evident by the fact that more than 90 percent of people who survive a suicide attempt do not go on to die by suicide. A suicide attempt with a firearm rarely affords a second chance," the researchers said in an article in the Sept. 4 issue of the New England Journal of Medicine.
Among Americans, guns are used in more than half of all completed suicides. Studies estimate that one-third to four-fifths of all suicide attempts are impulsive, with 24 percent of victims taking less than five minutes between the decision to kill themselves and the actual attempt, while 70 percent take less than one hour.
Suicide attempts that involve drugs or cutting account for more than 90 percent of all suicidal acts but are fatal far less often than attempts involving guns.
A Harvard Injury Control Research Center Web site provides guidance for physicians on how to assess and restrict an at-risk patient's access to lethal means, including advice on how to approach family members about the possible presence of a gun in the home and how to suggest to family members that guns be moved out of the house temporarily, or locked and stored more securely.
The Harvard team noted that suicidal crises are often caused by an immediate stressor, such as the loss of a job, the breakup of a romantic relationship, or a run-in with police. By intervening to get guns out of patients' reach during these critical times, physicians can help prevent many suicides.
"The suicide prevention field is where the motor vehicle safety movement was 50 years ago and the patient safety movement 20 years ago: The focus of prevention is almost exclusively on the individual," said study author Matthew Miller, associate director of the Harvard Injury Control Research Center. "Psychiatrists, psychologists and other medical professionals tend naturally to focus on the mental health of the individual patient, one patient at a time."
"We are proposing a population-based approach to reducing suicide. This approach recognizes that the physical environment [e.g., the availability of household guns in the U.S., the toxicity of pesticides in Sri Lanka, a frequent method of suicide there] can have a profound effect on the likelihood of completed suicide -- and that the physical environment can be modified to save lives. This approach is based on understanding that the number of Americans who die each year can be reduced not only by reducing the rate at which Americans attempt suicide [the traditional target of screening and treatment prevention efforts] but also, and perhaps most dramatically, by making it less likely that suicide attempts prove fatal. One of the best ways to reduce the probability that an impulsive suicidal act proves fatal is to remove firearms from the home."
Miller and study co-author David Hemenway noted that a number of U.S. studies have concluded that a gun in the home is associated with a two-to-10-times increased risk of suicide compared to homes without guns. Research has also found that the higher risk of completed suicide in homes with firearms applies not only to the gun owner but also to the gun owner's spouse and children.
"Too many clinicians seem to believe that anyone who uses a gun to attempt suicide must be serious enough that if a gun were not available, they would find an equally lethal way to kill themselves," said Hemenway, director of the Harvard Injury Control Research Center. "This belief is invalid. Physicians need to embrace all effective measures that can prevent completed suicide, including means restriction."
Posted: September 2008
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