Psychiatrists’ Practices and Perceptions Regarding Anticipatory Guidance on Firearms

BackgroundMost suicides (60%) and homicides (67%) are committed with firearms. Additionally, 90% of homicide offenders and 80% of individuals reporting suicide behaviors meet diagnostic criteria for mental illness. Medical society guidelines support the counseling of patients regarding firearms. This study assessed psychiatrists’ anticipatory guidance on firearms and their perceived roles on this topic.MethodA four-wave mail survey of adult psychiatrists in Ohio was conducted and analyzed. The outcome measures were the portion of psychiatrists involved in anticipatory guidance on firearm safety issues and their self-efficacy and perceived barriers regarding firearm counseling.ResultsTwo hundred and five psychiatrists of a possible 340 (60%) responded. Almost half (45%) had never thought seriously about discussing firearm safety issues with patients. They perceived firearm safety issues to be much greater (32%) or slightly greater (37%) for mental health patients than for the general population. Psychiatrists with high efficacy expectations were twice as likely (56.5% vs 28.0%) as those with low efficacy expectations to provide firearm anticipatory guidance. Those who counseled their patients were 15 times more likely to have high outcome expectations compared to those who did not counsel their patients (93.7% vs 6.3%, respectively).ConclusionsWhen psychiatrists are provided with firearm information, they were significantly more likely to be involved in anticipatory guidance regarding firearms. This implies that professional societies and journals should attempt to increase the information they provide to their members regarding this topic. Psychiatrists may be in a unique position to help reduce firearm morbidity and mortality for mentally ill patients.