Physician Self Reflection for Suicide Prevention Month

Written by Sarah Kimball, MD, NPA Gun Violence Prevention Taskforce Co-Chair
At night, after I’ve left my primary care clinic and put away my notes, I am occasionally haunted by a near-miss patient. The one who, at the end of the visit, pauses slightly when I ask if there are any more questions. On a busy or late clinic day, I might accept the silence as acknowledgement that there are no further issues, and move on to the next patient’s needs. More than once, when I have listened to my instinct to stop, I’ve found that that moment contains a painful offering from a patient. Too afraid to say that they are suicidal, but too afraid to leave without saying it, they wait until the last possible moment to put voice to their depression and suicidality.
With Suicide Prevention Month as the catalyst for self-reflection, I have to ask myself how many people have I missed, too rushed, too inobservant? According to the recent Brady Campaign publication, 77% of people who die by suicide some sort of contact with their primary care doctor in the year before their suicide. Depression and suicidal thoughts do not have to be lethal, but the presence of a firearm makes them much more likely to be so. When a person attempts suicide using a firearm, they are over forty five times more likely to die than if they attempt suicide by overdose. (
Not enough of our colleagues are talking to patients about common strategies to protect themselves and family members from the devastating effects of gun violence. In honor of Suicide Prevention Month, I ask you to consider sharing the following facts with patients who are at risk for gun violence. Our patients deserve to know the facts about gun violence so they can make informed choices to help keep themselves and their loved ones safe.

NPA has produced a variety of resources that we invite you to share with colleagues and/or patients who want to educate themselves about the risk of gun violence, please refer those who are interested to the resources at this link.

In a world where gun violence has become so numbingly commonplace, it is natural to have compassion and activism fatigue. But suicide and depression are issues that touch all of us, whether we know it or not. As health care providers, we need to be asking our patients about their access to lethal means, particularly when they present with depression. As family members and friends, we have to ask the people we love when we are concerned. And as gun violence prevention activists, we have to reach beyond our compassion fatigue and see the rampaging epidemic of gun violence that is causing too many deaths and injuries to innocent people.

Facts to Know from The Truth About Suicide & Guns

  • Two-thirds of all gun deaths in the U.S. are suicides.
  • Half of all suicides involve a firearm. On average, guns account for 20,000 suicides every year.
  • A gun in the home increases the risk of suicide more than 3 times for all members of the household.

Facts to Know from the Harvard University School of Public Health

  • Suicide is often impulsive: 71% of attempts take place within one hour of making the decision
  • Suicide attempts with a gun are 85% fatal—more than all other methods combined
  • Gun availability is a significant risk factor: 52% of suicides involve firearms