An Interactive Web-Based Lethal Means Safety Decision Aid for Suicidal Adults (Lock to Live): Pilot Randomized Controlled Trial

Overview

Journal J Med Internet Res

Publisher JMIR Publications

Specialty Medical Informatics

Date 2020 Feb 4

PMID 32012056

Citations 17

Authors

Marian E Betz

Christopher E Knoepke

Scott Simpson

Bonnie J Siry

Ashley Clement

Tamara Saunders

Rachel Johnson

Deborah Azrael

Edwin D Boudreaux

Faris Omeragic

Leah M Adams

Sydney Almond

Elizabeth Juarez-Colunga

Daniel D Matlock

Affiliations

Soon will be listed here.

Abstract

Background: Counseling to reduce access to lethal means such as firearms and medications is recommended for suicidal adults but does not routinely occur. We developed the Web-based Lock to Live (L2L) decision aid to help suicidal adults and their families choose options for safer home storage.

Objective: This study aimed to test the feasibility and acceptability of L2L among suicidal adults in emergency departments (EDs).

Methods: At 4 EDs, we enrolled participants (English-speaking, community-dwelling, suicidal adults) in a pilot randomized controlled trial. Participants were randomized in a 13:7 ratio to L2L or control (website with general suicide prevention information) groups and received a 1-week follow-up telephone call.

Results: Baseline characteristics were similar between the intervention (n=33) and control (n=16) groups. At baseline, many participants reported having access to firearms (33/49, 67%), medications (46/49, 94%), or both (29/49, 59%). Participants viewed L2L for a median of 6 min (IQR 4-10 min). L2L also had very high acceptability; almost all participants reported that they would recommend it to someone in the same situation, that the options felt realistic, and that L2L was respectful of values about firearms. In an exploratory analysis of this pilot trial, more participants in the L2L group reported reduced firearm access at follow-up, although the differences were not statistically significant.

Conclusions: The L2L decision aid appears feasible and acceptable for use among adults with suicide risk and may be a useful adjunct to lethal means counseling and other suicide prevention interventions. Future large-scale studies are needed to determine the effect on home access to lethal means.

Trial Registration: ClinicalTrials.gov NCT03478501; https://clinicaltrials.gov/ct2/show/NCT03478501.

Citing Articles

Reducing Firearm Access for Suicide Prevention: Implementation Evaluation of the Web-Based "Lock to Live" Decision Aid in Routine Health Care Encounters.

Angerhofer Richards J, Kuo E, Stewart C, Shulman L, Parrish R, Whiteside U JMIR Med Inform. 2024; 12:e48007.

PMID: 38647319 PMC: 11063417. DOI: 10.2196/48007.

Behavioural mental health interventions delivered in the emergency department for suicide, overdose and psychosis: a scoping review.

Nugent S, Anderson J, Young S BMJ Open. 2024; 14(3):e080023.

PMID: 38531581 PMC: 10966803. DOI: 10.1136/bmjopen-2023-080023.

Decision aids for people facing health treatment or screening decisions.

Stacey D, Lewis K, Smith M, Carley M, Volk R, Douglas E Cochrane Database Syst Rev. 2024; 1:CD001431.

PMID: 38284415 PMC: 10823577. DOI: 10.1002/14651858.CD001431.pub6.

A Randomized Control Trial of a Digital Health Tool for Safer Firearm and Medication Storage for Patients with Suicide Risk.

Boggs J, Quintana L, Beck A, Clarke C, Richardson L, Conley A Prev Sci. 2024; 25(2):358-368.

PMID: 38206548 DOI: 10.1007/s11121-024-01641-6.

Comparing the Acceptability and Quality of Intervention Modalities for Suicidality in the Emergency Department: Randomized Feasibility Trial.

Larkin C, Tulu B, Djamasbi S, Garner R, Varzgani F, Siddique M JMIR Ment Health. 2023; 10:e49783.

PMID: 37874619 PMC: 10630858. DOI: 10.2196/49783.

References

Karras E, Stokes C, Warfield S, Barth S, Bossarte R . A randomized controlled trial of public messaging to promote safe firearm storage among U.S. military veterans. Soc Sci Med. 2019; 241:112205. PMC: 7561038. DOI: 10.1016/j.socscimed.2019.03.001. View

Anestis M, Houtsma C . What I have is what I am: Differences in demographics, suicidal thoughts and behaviors, and firearm behavior and beliefs between firearm owners who do and do not primarily identify as firearm owners. J Psychiatr Res. 2019; 116:157-165. DOI: 10.1016/j.jpsychires.2019.06.017. View

Posner K, Brown G, Stanley B, Brent D, Yershova K, Oquendo M . The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry. 2011; 168(12):1266-77. PMC: 3893686. DOI: 10.1176/appi.ajp.2011.10111704. View

Betz M, Miller M, Barber C, Beaty B, Miller I, Camargo Jr C . LETHAL MEANS ACCESS AND ASSESSMENT AMONG SUICIDAL EMERGENCY DEPARTMENT PATIENTS. Depress Anxiety. 2016; 33(6):502-11. PMC: 4800489. DOI: 10.1002/da.22486. View

Weinberger S, Hoyt D, Lawrence 3rd H, Levin S, Henley D, Alden E . Firearm-related injury and death in the United States: a call to action from 8 health professional organizations and the American Bar Association. Ann Intern Med. 2015; 162(7):513-6. DOI: 10.7326/M15-0337. View

. Detecting and treating suicide ideation in all settings. Sentinel Event Alert. 2016; (56):1-7. View

Bulger E, Kuhls D, Campbell B, Bonne S, Cunningham R, Betz M . Proceedings from the Medical Summit on Firearm Injury Prevention: A Public Health Approach to Reduce Death and Disability in the US. J Am Coll Surg. 2019; 229(4):415-430.e12. DOI: 10.1016/j.jamcollsurg.2019.05.018. View

Roszko P, Ameli J, Carter P, Cunningham R, Ranney M . Clinician Attitudes, Screening Practices, and Interventions to Reduce Firearm-Related Injury. Epidemiol Rev. 2016; 38(1):87-110. PMC: 7297261. DOI: 10.1093/epirev/mxv005. View

Petrik M, Gutierrez P, Berlin J, Saunders S . Barriers and facilitators of suicide risk assessment in emergency departments: a qualitative study of provider perspectives. Gen Hosp Psychiatry. 2015; 37(6):581-6. DOI: 10.1016/j.genhosppsych.2015.06.018. View

10.

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. Gen Hosp Psychiatry. 2012; 34(6):692-8. DOI: 10.1016/j.genhosppsych.2012.07.012. View

11.

Betz M, Brooks-Russell A, Brandspigel S, Novins D, Tung G, Runyan C . Counseling Suicidal Patients About Access to Lethal Means: Attitudes of Emergency Nurse Leaders. J Emerg Nurs. 2018; 44(5):499-504. PMC: 6150796. DOI: 10.1016/j.jen.2018.03.012. View

12.

Kelly T, Brandspigel S, Polzer E, Betz M . Firearm Storage Maps: A Pragmatic Approach to Reduce Firearm Suicide During Times of Risk. Ann Intern Med. 2020; 172(5):351-353. DOI: 10.7326/M19-2944. View

13.

Anestis M, Butterworth S, Houtsma C . Perceptions of firearms and suicide: The role of misinformation in storage practices and openness to means safety measures. J Affect Disord. 2017; 227:530-535. DOI: 10.1016/j.jad.2017.11.057. View

14.

Wintemute G, Betz M, Ranney M . Yes, You Can: Physicians, Patients, and Firearms. Ann Intern Med. 2016; 165(3):205-13. DOI: 10.7326/M15-2905. View

15.

Knoepke C, Allen A, Ranney M, Wintemute G, Matlock D, Betz M . Loaded Questions: Internet Commenters' Opinions on Physician-Patient Firearm Safety Conversations. West J Emerg Med. 2017; 18(5):903-912. PMC: 5576627. DOI: 10.5811/westjem.2017.6.34849. View

16.

Betz M, Knoepke C, Siry B, Clement A, Azrael D, Ernestus S . 'Lock to Live': development of a firearm storage decision aid to enhance lethal means counselling and prevent suicide. Inj Prev. 2018; 25(Suppl 1):i18-i24. PMC: 6533157. DOI: 10.1136/injuryprev-2018-042944. View

17.

Spicer R, Miller T . Suicide acts in 8 states: incidence and case fatality rates by demographics and method. Am J Public Health. 2000; 90(12):1885-91. PMC: 1446422. DOI: 10.2105/ajph.90.12.1885. View

18.

Miller M, Azrael D, Hemenway D . The epidemiology of case fatality rates for suicide in the northeast. Ann Emerg Med. 2004; 43(6):723-30. DOI: 10.1016/j.annemergmed.2004.01.018. View

19.

Gurmankin Levy A, Scherer A, Zikmund-Fisher B, Larkin K, Barnes G, Fagerlin A . Assessment of Patient Nondisclosures to Clinicians of Experiencing Imminent Threats. JAMA Netw Open. 2019; 2(8):e199277. PMC: 6694393. DOI: 10.1001/jamanetworkopen.2019.9277. View

20.

Mann J, Michel C . Prevention of Firearm Suicide in the United States: What Works and What Is Possible. Am J Psychiatry. 2016; 173(10):969-979. DOI: 10.1176/appi.ajp.2016.16010069. View