• Jennifer M Boggs, Arne Beck, Debra P Ritzwoller, Catherine Battaglia, Heather D Anderson, and Richard C Lindrooth.
• Kaiser Permanente Colorado Institute for Health Research, 2550 S. Parker Rd., Suite 200, Aurora, CO, 80014, USA. Jennifer.m.boggs@kp.org.
• J Gen Intern Med. 2020 Jun 1; 35 (6): 170917141709-1714.

BackgroundCounseling on access to lethal means is highly recommended for patients with suicide risk, but there are no formal evaluations of its impact in real-world settings.ObjectiveEvaluate whether lethal means assessment reduces the likelihood of suicide attempt and death outcomes.DesignQuasi-experimental design using an instrumental variable to overcome confounding due to unmeasured patient characteristics that could influence provider decisions to deliver lethal means assessment.SettingKaiser Permanente Colorado, an integrated health system serving over 600,000 members, with comprehensive capture of all electronic health records, medical claims, and death information.ParticipantsAdult patients who endorsed suicide ideation on the Patient Health Questionnaire-9 (PHQ-9) depression screener administered in behavioral health and primary care settings from 2010 to 2016.InterventionsProvider documentation of lethal means assessment in the text of clinical notes, collected using a validated Natural Language Processing program.MeasurementsMain outcome was ICD-9 or ICD-10 codes for self-inflicted injury or suicide death within 180 days of index PHQ-9 event.ResultsWe found 33% of patients with suicide ideation reported on the PHQ-9 received lethal means assessment in the 30 days following identification. Lethal means assessment reduced the risk of a suicide attempt or death within 180 days from 3.3 to 0.83% (p = .034, 95% CI = .069-.9).LimitationsUnmeasured suicide prevention practices that co-occur with lethal means assessment may contribute to the effects observed.ConclusionsClinicians should expand the use of counseling on access to lethal means, along with co-occurring suicide prevention practices, to all patients who report suicide ideation.

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