Most Veterans Endorse Clinician-Initiated Firearm Safety Discussions Based on Veteran/Family Member Risk

BACKGROUND:
Roughly 50% of Veterans own firearms, and Veterans are at increased risk of suicide. Guidelines recommend assessing firearm access as well as counseling to reduce access among patients with elevated suicide risk. However, clinician-initiated discussions about firearm safety are uncommon, partly due to the perception that firearm owners might be opposed to discussing firearms. How Veterans view such discussions is critical to the effectiveness of these interactions. This study examined data from the online July-August 2019 National Firearms Survey to assess whether Veteran firearm owners believe clinicians should provide firearm counseling when specific clinical contexts suggest heightened risk of firearm injury to the patient or their family. Study participants were 678 self-identified Veteran firearm owners. A majority (57%) were 60 years or older and male (93%). Participants were asked: “As part of routine care, should physicians and/or other healthcare professionals talk with their patients about firearms and firearm safety if their patient or their patient’s family member is at risk of suicide; has mental health or behavioral problems; is abusing or addicted to alcohol or drugs; is a victim of domestic violence; has Alzheimer’s disease or another dementia; or is going through a hard time?” Response options included “No,” “Yes, sometimes,” and “Yes, always.”

FINDINGS:

• Across all six proposed clinical contexts, a large majority (73–88%) of Veteran firearm owners reported that firearm counseling should be delivered as part of routine care when they or someone in their family is at increased risk of firearm injury.
• Regional differences were minor; regardless of where firearm owners lived, at least two-thirds endorsed routine lethal means counseling “at least sometimes.”

IMPLICATIONS:

• Findings should allay concerns among clinicians, healthcare leaders, and policy makers that discussing firearms with Veterans who are—or who have family members who are—at heightened risk of suicide and other firearm injuries will be viewed as beyond the scope of routine medical care.
• Findings provide support for clinic-based initiatives that aim to prevent injuries that extend beyond suicide to include people in Veterans’ homes who are at heightened risk of firearm assault and unintentional firearm injury, as well as clinical scenarios such as dementia care or intimate partner violence.

LIMITATIONS:

• Because data are self-reported, misclassification is possible, and social desirability or selection biases might have skewed findings.

AUTHOR/FUNDING INFORMATION:
Dr. Aunon is part of HSR&D’s Pain Research, Informatics, Multi-morbidities, and Education Center in West Haven, CT.

Aunon FM, Azrael D, Simonetti JA, and Miller M. Beliefs Among Veteran Firearm Owners Regarding Whether Clinicians Should Discuss Firearm Safety with Patients. JAMA Network Open. June 29, 2023;6(6):e2321219.