Lethal Means Restriction for Suicide Prevention: Beliefs and Behaviors of Emergency Department Providers

UMMS Affiliation

Department of Emergency Medicine; Department of Psychiatry; Center for Health Policy and Research

Publication Date


Document Type



Suicide; Firearms; Emergency Service, Hospital; Emergency Medical Services


Emergency Medicine | Health Services Research | Mental and Social Health | Psychiatry | Psychiatry and Psychology


BACKGROUND: We sought to examine the beliefs and behaviors of emergency department (ED) providers related to preventing suicide by reducing suicidal patients' access to lethal methods (means restriction) and identify characteristics associated with asking patients about firearm access.

METHODS: Physicians and nurses at eight EDs completed a confidential, voluntary survey.

RESULTS: The response rate was 79% (n = 631); 57% of respondents were females and 49% were nurses. Less than half believed, "most" or "all" suicides are preventable. More nurses (67%) than physicians (44%) thought "most" or "all" firearm suicide decedents would have died by another method had a firearm been unavailable (P < .001). The proportion of providers who reported they "almost always" ask suicidal patients about firearm access varied across five patient scenarios: suicidal with firearm suicide plan (64%), suicidal with no suicide plan (22%), suicidal with nonfirearm plan (21%), suicidal in past month but not today (16%), and overdosed but no longer suicidal (9%). In multivariable logistic regression, physicians were more likely than nurses to "almost always" or "often" ask about a firearm across all five scenarios, as were older providers and those who believed their own provider type was responsible for assessing firearm access.

CONCLUSIONS: Many ED providers are skeptical about the preventability of suicide and the effectiveness of means restriction, and most do not assess suicidal patients' firearm access except when a patient has a firearm suicide plan. These findings suggest the need for targeted staff education concerning means restriction for suicide prevention.

DOI of Published Version



Betz ME, Miller M, Barber C, Miller I, Sullivan AF, Camargo CA Jr, Boudreaux ED; ED-SAFE Investigators. Lethal means restriction for suicide prevention: beliefs and behaviors of emergency department providers. Depress Anxiety. 2013 Oct;30(10):1013-20. doi: 10.1002/da.22075. Link to article on publisher's site

Journal/Book/Conference Title

Depression and anxiety


The ED-SAFE Investigators include Edward W. Boyer, Robin E. Clark, Mardia A. Coleman, and Barry N. Feldman of the University of Massachusetts Medical School.

Related Resources

Link to Article in PubMed

PubMed ID