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Standing AFFIRM

Standing AFFIRM

Firearm Suicide: A Pressing and Personal Issue for EPs

Morgan, Kristen E. MPH; Bragg, Hunter; Joshi, Nikita K. MD

doi: 10.1097/
    firearms, suicide

    When the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM) held its first annual meeting a year ago, with more than 50 medical and public health professionals from more than 15 partner organizations in attendance, every person there had been touched by gun violence, professionally or personally. That, unfortunately, is a commonality the majority of Americans share.

    Mass shootings tend to occupy most of the national attention in the United States, but a far greater number of lives are lost in the shadows, away from media attention and discussion, to firearm suicide. This silent and growing epidemic quietly preys upon its victims and their families in ways that are just as horrifying as mass shootings. (CDC Fatal Injury Data. My own family (Ms. Morgan) knows this to be true: My older brother took his own life using a firearm he purchased when he was only 29 years old.

    Research shows that firearms are the deadliest means of taking one's life. Other methods of suicide average a 10 percent mortality rate, but access to a firearm increases that to 85 percent. (Annu Rev Public Health. 2012;33:393;

    What may come as a surprise, though, is that most people who die by suicide are seen by a health care provider in the month prior to their death. (Am J Psychiatry. 2002;159[6]:909; This means health care providers are one of the last lifelines to which people in crisis have access. With such an opportunity to intervene and save lives, we have a duty to equip health care providers with the best resources and interventions to help these patients.

    Most health care professionals do not counsel patients about firearm safety or ownership. Less than one-fifth of suicidal patients in emergency departments are assessed for their access to a gun, and how to reduce access is discussed in less than 10 percent of encounters. (Psychiatry Res. 2018;260:30;

    Mitigating Risk

    Health professionals too often see victims of firearm injury after it is too late to intervene. Instead of seeking answers in the back of an ambulance or on the operating table, physicians should be looking further upstream for opportunities to mitigate risk. By asking outright about the mental state of patients, EPs can help increase their likelihood of accepting help and surviving. One great resource is the What You Can Do program at UC Davis. (

    Discussing firearms and suicide is taboo for many Americans. Despite the overwhelming majority of us having been affected by firearm violence or suicide, these issues are missing from, or misrepresented in, much of the media coverage and even general conversation.

    Perhaps people feel that by avoiding these uncomfortable topics, these events would be less likely to happen. Or perhaps we have grown weary of gun debates that often devolve into political divides, but this reluctance to speak openly as a society does a disservice to us all.

    Physicians themselves are in a profession with the highest rate of suicide in the United States: One doctor dies by suicide in the United States every day, and the number of physician suicides (28 to 40 per 100,000) is more than twice that of the general population. (Medscape. May 7, 2018; Physicians are at the center of this epidemic personally and professionally. They have the ability to change the terms of this unnecessarily politically charged topic from an issue of firearm ownership to a discussion of risk management and safety for victims of firearm suicide and violence as a whole. AFFIRM Research seeks to do just that through community engagement, by developing education programs, and by funding research to better understand how to intervene before we lose another family member, friend, or colleague to firearm suicide.

    Join us in starting a conversation and a movement to turn the tide of this epidemic. The second annual AFFIRM Research Summit took place in Chicago this month. Convening more than 20 national partners and community stakeholders, we know that any step we take together is a step forward.


    The National Suicide Prevention Lifeline is a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, seven days a week. Learn more at or 1-800-273-TALK (8255).

    Text HOME to 741741 from anywhere in the United States anytime about any type of crisis. Find more information on secure storage of firearms and how you can help others improve their storage practices at

    Clockwise from top left: Ms. Morganis a project manager at AFFIRM Research based in Chicago, IL. Mr. Braggis a marketing operations analyst at AFFIRM Research based in San Diego, CA. Dr. Joshiis a clinical assistant professor and faculty at Highland Hospital in Oakland, CA, the medical director at Alameda Hospital Department of Emergency Medicine, and the director of Education and Outreach at AFFIRM Research. Follow her on Twitter@njoshi8.

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