|
Abstract
|
Key points
• Lethal means safety (reducing access to highly lethal methods of suicide, like firearms) is a key component of suicide prevention.
• Means safety interventions can be applied at multiple levels, from society (eg, laws), community (eg, partnerships and education), and interpersonal relationships (eg, engaging friends and family) to individuals (eg, changing behavior in storing dangerous items).
• Approaches and challenges vary between geographic regions and cultures depending on the most common methods of suicide as well as political considerations (eg, acceptability of legislation to reduce access to methods such as firearms).
Suicide is a global public health problem that affects people across the life span. Across the world, over 800,000 people die by suicide each year. In 2016 suicide was the 18th leading cause of death worldwide, accounting for 1.4% of all deaths. Suicide affects all socioeconomic groups, sexes, and geographic regions [1]. In the United States, nearly 50,000 people die by suicide each year, and suicide is the 10th leading cause of death in 2018 [2]. From 1999 to 2018, suicide rates in the United States increased by 35%, approximately 2% each year between 2006 and 2018 [3]. Suicide was also the second leading cause of death for persons aged 10 to 14, 15 to 19, and 20 to 24 in 2017, with the rate of increase during this time higher than the preceding 5 years [4]. These worsening rates highlight the importance of taking action to prevent suicides and reduce the lethality of attempts.
Suicide prevention is complex from the individual to societal level, and it generally requires a comprehensive, multipronged approach [5]. This approach includes the identification of at-risk individuals, effective care and treatment (including care linkages), response to crisis (for those in crisis, those around them, and postvention interventions after a suicide), and interventions to build resilience, life skills, and connectedness. Another critical component of this comprehensive approach is lethal means safety (previously referred to as "means restriction," a less-preferred term [6]). Means safety approaches are built on studies and conceptual theories showing that suicide attempts can occur after only a short period of deliberation [[7], [8], [9]]. Access to a lethal method of suicide during the period of highest risk can increase the likelihood of death should an attempt occur. Thus, means safety approaches work by reducing physical access to methods, thereby delaying an attempt (temporarily or permanently) (Fig. 1). Even if a person substitutes a second method, that method is less likely to be lethal, assuming the most lethal methods (eg, firearms) are the ones to which access has been reduced. Thus, lethal means safety can attenuate or eliminate the role of a critical factor (access to means) during a time of vulnerability and reduce the likelihood of suicide attempts or death [10]. Implementation of means safety approaches varies by setting, from population-based policies to individual-level intervention.
Language: en |