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RRP 07-284 – QUERI Project

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RRP 07-284
Suicide and Firearm Experience (SAFE): Developing Strategies to Increase Veterans Safety
Marcia T. Valenstein MD AB
VA Ann Arbor Healthcare System, Ann Arbor, MI
Ann Arbor, MI
Funding Period: October 2007 - April 2008

BACKGROUND/RATIONALE:
VA users have a suicide rate of 43/100,000 person-years, exceeding the rate in age and gender adjusted US population. Sixty-six percent of suicides among VA users are completed with firearms.

Only a few prevention strategies have reasonable evidence for reducing suicide. One of these is restriction of access to lethal means. Developing and implementing interventions to delay or reduce access to guns may be critical to the success of VHA's goal of reducing suicide.

OBJECTIVE(S):
The objectives of this study were to 1) better understand veteran and other stakeholders' perceptions and concerns regarding gun accessibility and safety, 2) elicit ideas regarding interventions that might delay gun access and improve safety, and 3) develop and pretest a survey that will document the prevalence of gun access among VA patients, efforts to ensure gun safety, and patient willingness to participate in a variety of interventions to increase safety.

METHODS:
Focus groups were conducted for Veterans Affairs (VA) patients, family members of current VA mental health patients, mental health clinicians, and Veteran Service Organization (VSO) and local gun club members. Semi-structured, individual interviews were completed with VA leaders and legal representatives. Audiorecordings
of the focus groups/interviews were transcribed and qualitative data analyses completed.

Using these data, we developed a survey eliciting patient input on issues relevant to gun access and safety. The survey will be pre-tested and mailed to a random sample of 200 VA patients. These data will be used to estimate the prevalence of gun access, current safety measures, and to estimate sample sizes needed to ascertain differences in acceptability of variety of interventions to increase gun safety.

FINDINGS/RESULTS:
We completed five focus groups of mental health patients (n=24), two groups of mental health clinicians (n=12), two groups of family members (n=12) and one VSO group (n=8). We also completed 4 individual interviews with VA facility and VISN leadership (total N=59).

Patients, clinicians, family members, and VSO members considered the VA to have a legitimate role in addressing firearm safety within the context of suicide prevention. Several measures to delay access to guns during high-risk periods appeared acceptable to VA patients and clinicians, if judiciously applied.

IMPACT:
Study data will inform investigators, policy makers, and VA leaders regarding potential interventions that might be acceptable to VA stakeholders to increase gun safety and reduce suicide.

PUBLICATIONS:

Journal Articles

  1. Valenstein M, Walters H, Pfeiffer PN, Ganoczy D, Ilgen MA, Miller MJ, Fiorillo M, Bossarte RM. Possession of Household Firearms and Firearm-Related Discussions with Clinicians Among Veterans Receiving VA Mental Health Care. Archives of suicide research : official journal of the International Academy for Suicide Research. 2019 Feb 8; 1-20.
  2. Walters H, Kulkarni M, Forman J, Roeder K, Travis J, Valenstein M. Feasibility and acceptability of interventions to delay gun access in VA mental health settings. General hospital psychiatry. 2012 Nov 1; 34(6):692-8.


DRA: Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders
DRE: Diagnosis, Prevention
Keywords: Operation Enduring Freedom, Operation Iraqi Freedom, Risk factors
MeSH Terms: none

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