Marian E. Betz, MD, MPH; Alexander D. McCourt, JD, MPH; Jon S. Vernick, JD, MPH; Megan L. Ranney, MD, MPH; Donovan T. Maust, MD, MS; Garen J. Wintemute, MD, MPH
Disclaimer: The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the funding agencies.
Financial Support: By the Paul Beeson Career Development Award Program from the National Institute on Aging, American Federation for Aging Research, The John A. Hartford Foundation, and The Atlantic Philanthropies (grants K23AG043123 and K08AG048321); the Heising-Simons Foundation (grant 2016-219); and the National Institute of Mental Health (grant K23 MH095866). No sponsor had any direct involvement in the study design, methods, participant recruitment, data collection, analysis, or manuscript preparation.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0140.
Corresponding Author: Marian E. Betz, MD, MPH, Mail Stop B215, Leprino Building, University of Colorado School of Medicine, 12401 East 17th Avenue, Aurora, CO 80045; e-mail, email@example.com.
Current Author Addresses: Dr. Betz: Mail Stop B215, Leprino Building, 12401 East 17th Avenue, Aurora, CO 80045.
Mr. McCourt: Johns Hopkins Bloomberg School of Public Health, Center for Gun Policy and Research, 624 North Broadway, Baltimore, MD 21205.
Mr. Vernick: Johns Hopkins Bloomberg School of Public Health, Center for Gun Policy and Research, 624 North Broadway, Hampton House Room 594, Baltimore, MD 21205.
Dr. Ranney: Department of Emergency Medicine, Alpert Medical School, Brown University/Rhode Island Hospital, 593 Eddy Street, Claverick 2, Providence, RI 02903.
Dr. Maust: University of Michigan, North Campus Research Complex 016-226w, 2800 Plymouth Road, Ann Arbor, MI 48109.
Dr. Wintemute: Violence Prevention Research Program, University of California, Davis, 2315 Stockton Boulevard, Sacramento, CA 95817.
Author Contributions: Conception and design: M.E. Betz, J.S. Vernick, M.L. Ranney, G.J. Wintemute.
Analysis and interpretation of the data: M.E. Betz, A.D. McCourt, J.S. Vernick, M.L. Ranney.
Drafting of the article: M.E. Betz, A.D. McCourt, J.S. Vernick, M.L. Ranney, D.T. Maust, G.J. Wintemute.
Critical revision of the article for important intellectual content: M.E. Betz, J.S. Vernick, M.L. Ranney, D.T. Maust, G.J. Wintemute.
Final approval of the article: M.E. Betz, A.D. McCourt, J.S. Vernick, M.L. Ranney, D.T. Maust, G.J. Wintemute.
Obtaining of funding: G.J. Wintemute.
Administrative, technical, or logistic support: M.E. Betz, M.L. Ranney.
Collection and assembly of data: M.E. Betz, A.D. McCourt, M.L. Ranney.
Table. Recommendations for Screening and Counseling Based on Dementia Stage*
Sample family firearm agreement.
Adapted from www.thehartford.com/sites/thehartford/files/at-the-crossroads-2012.pdf.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Alan R. Ertle, MD, MPH, MBA
Mercy Medical Group, Inc.
July 16, 2018
Firearm Suicide and Dementia: Only a Small Part of the Problem
I read the article by Betz, et. al., with interest. However, I was disappointed to find that the actual size of the problem of suicide by firearms in patients with dementia (PWD) was not clarified. There is only a theoretical context in that there is a growing number of patients with dementia, some of whom will commit suicide by firearm, and lots of households with firearms. In 2011 an article was published by Seyfried, et. al., that described a 2001-2005 retrospective analysis of the Department of Veterans Affairs data of 294,952 patients (97.2% male) who had dementia and they found that there were 241 suicides during that period, 72.6% by firearms.1 This is estimated to be 11.9 suicides by firearm per 100,000 PWDs per year. There were potential predictors identified including male gender, white race, depression, a history of an inpatient psychiatric stay, prescriptions for antidepressants, and prescriptions for antianxiety medications. The authors of this study also indicate that suicide was much more likely early in the diagnosis. While suicide by firearms is not common in PWD, it does occur, and this is likely to be similar to other patients who are told of a terminal diagnosis or other serious illness. While the general recommendations seem sound, the Betz article would have been more useful if the scope were broadened to discuss the issue of suicide by firearms in all patients given a terminal or serious diagnosis.
Betz ME, McCourt AD, Vernick JS, Ranney ML, Maust DT, Wintemute GJ. Firearms and Dementia: Clinical Considerations. Ann Intern Med. 2018;169:47–49. doi: 10.7326/M18-0140
Download citation file:
Published: Ann Intern Med. 2018;169(1):47-49.
Published at www.annals.org on 8 May 2018
Results provided by:
Copyright © 2018 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use