Firearm Suicide Prevention in the Military Health System: A Qualitative Study of Clinician Training, the "Lock to Live" Decision Aid, and Connection to Out-of-Home Firearm Storage.

Suicide remains a leading cause of death in the U.S. military, with the majority of suicides enacted by firearm. A recommended intervention for suicide prevention in clinical settings, including in the Military Health System (MHS), is counseling at-risk patients about reducing access to firearms and other lethal means of suicide. The team sought to examine MHS clinicians' views on a firearm suicide prevention toolkit that included (1) clinician training, (2) the "Lock to Live" (L2L) decision aid, and (3) connection to out-of-home firearm storage options. The study team conducted one-on-one, semi-structured qualitative interviews with MHS clinicians, administrators, and other stakeholders (January-October 2022). Interviewees viewed the toolkit items and completed a brief questionnaire. The study used a team-based, mixed deductive-inductive approach to qualitative analysis. The study had institutional review board approval. Across interviews (n = 18), there was general support for the lethal means safety counseling toolkit, including clinician training, L2L use, and connection to out-of-home storage options. Participants also provided recommendations for optimal uptake in the MHS, including military-specific messaging. Firearm suicide prevention is a key focus within the Department of Defense, and the findings from this qualitative study can support incorporation of tools for MHS clinicians and patients.