Firearms and Dementia: Clinical Considerations Free

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.

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

(multiple)

July 26, 2018

Authors respond to Dr. Ertle

We agree with Dr. Ertle that dementia is not the only condition that elevates suicide risk – indeed, suicide risk relates to a number of static and transient factors including physical and mental health conditions and social stressors. In all of these cases, access to firearms can elevate acute risk of death because of the high lethality of firearms as a method of suicide. In other publications, we, and many other authors, have discussed firearm suicide prevention in other populations. In “Firearms and Dementia: Clinical Considerations” we sought instead to explore the various firearm injury risks that might be associated with dementia. Dr. Ertle is correct that epidemiologic data are lacking, and we strongly support increasing funding for research and injury surveillance system. In the meantime, however, clinicians and families face decisions about firearm access on a daily basis, and they deserve guidance and resources.