Gun violence: The role of doctors in this public health emergency
Key Takeaways
In addition to taking thousands of lives per year, gun violence is associated with increased rates of mental disorders, infant health issues, and poor emotional well-being among those who experience it.
Doctors may take a public health approach to prevention by identifying and addressing patient behaviors and circumstances that could increase that individual’s risk of experiencing gun violence.
Physicians can help patients at risk for experiencing gun violence by screening them for depression and intimate partner violence, and providing treatment or referring them to appropriate services.
Gun violence in the US has become an increasingly politicized issue. As legislators debate this hot-button topic, the national public health epidemic attributed to gun violence continues.
Research says that doctors have long been discouraged from speaking to patients about gun violence, despite its negative impact on health outcomes. However, physicians may help to prevent gun violence from harming patients by screening for depression and intimate partner violence (IPV), as well as initiating conversations about safe gun storage.
How gun violence impacts health outcomes
Gun violence is an umbrella term that includes many forms of physical and emotional harm associated with firearms, including suicides, homicides, violent crimes, and unintentional injuries or deaths.
According to a position paper published by the American Academy of Family Physicians (AAFP), nearly 60% of all gun-related deaths in the US are a result of suicide.[]
Between 85% to 91% of suicide attempts involving guns result in death. For other methods by which patients attempt suicide, the death rate is 3% or less.
The prevalence of IPV-related gun violence in the US is also noteworthy. The AAFP reported that women in the US are approximately 16 times more likely to die a firearm-related death compared with those in other developed nations, with IPV being the driving force for these incidents.
For example, in 2015, more than 1,750 women and girls were victims of IPV-related homicides; this form of homicide is most common among non-Hispanic Black and American Indian/Alaskan Native women, according to the AAFP research.
In addition to the physical harms associated with gun violence, there are emotional harms, including the pervasive detrimental effects linked to mass shootings.[]
Because gun violence has a direct impact on health outcomes, experts are calling for it to be recognized as a national public health epidemic.
Research and evidence-based strategies are required to mitigate gun-related morbidity and mortality.
Regional patterns of gun violence
The geography of gun violence throughout the US isn’t completely random. A study published by JAMA Network Open looked at the association between states’ firearm laws and firearm-related deaths in neighboring states.[]
Researchers used a spatial autoregressive model to assess in-state, interstate, and overall associations between firearm legislation and firearm-related deaths. During the study period, between January 1, 2000 and December 31, 2019, 662,883 firearm-related deaths were recorded.
The researchers found that states with laws requiring a license for firearm purchases had fewer in-state, interstate, and overall firearm-related deaths—including homicide.
These results indicate that synergic legislative action in neighboring states, federal firearm legislation, and efforts to reduce migration of firearms across state lines may help reduce firearm-related deaths, according to the study authors.
Although policy changes may be an effective means to prevent gun-related deaths, how may physicians help prevent gun violence among their patients?
Start the conversation
Doctors who address gun violence in the exam room may receive criticism for doing so.
According to an interview published by Penn Medicine, physicians may be told they don’t have the right to talk with patients about gun safety—even though gun violence is considered to be a public health epidemic.[]
Therese S. Richmond, PhD, RN, FAAN, public health and research expert, likened the public health issue of gun violence to a patient with heart disease.
"Think about if the healthcare community didn't also focus on prevention of heart disease, didn't focus on poor diet, on obesity; didn't focus on blood pressure control, didn't focus on getting your cholesterol down."
— Therese S. Richmond, PhD, RN, FAAN
“I would say, the majority of the world would view us as being negligent at best, or it would be malpractice at worst,” Dr. Richmond added. “So, how is gun violence any different than that?”
Multi-tiered approach
Health organizations like the AAFP, however, do encourage doctors to tackle the issue in the exam room using a multidisciplinary approach.
One way to prevent gun-related suicide and homicide among patients, as suggested by AAFP, is by screening them for depression and IPV. Based on what’s learned from these screenings, next steps could include providing treatments or referrals to appropriate services.
Preventing unintentional deaths by firearms, however, may require clinicians to talk to patients about safe ways to handle and store guns, according to the AAFP.
The responsibility to reduce gun violence is one shared by policymakers and public health officials alike. The effectiveness of taking a comprehensive, multidisciplinary approach to prevention should not be underestimated.
What this means for you
Public health professionals can help reduce the harm caused by gun violence by working together and taking comprehensive, interdisciplinary approaches to prevention. Screening for and treating depression, addressing IPV, and referring patients to appropriate services are a few actions you can take to help prevent gun violence. Talking with your patients about how to safely handle and store guns may also help.