(WITHDRAWN) Firearm Retailers and Suicide: Results from a Survey Assessing Willingness to Engage in Prevention Efforts

Background: Firearms are a highly lethal means of suicide, accounting for over half of all suicide deaths in the United States. Firearm retailers may be in a good position to disseminate suicide prevention messaging with firearm purchases and to intervene in suicidal crises with customers who are purchasing firearms with the intention of suicide. Few studies have sought to identify factors influencing firearm retailers’ willingness to engage in these ways. The purpose of the present study is to begin exploring potential avenues for enlisting firearm retailers in systems of care for suicide prevention.

Methods: A cross-sectional survey designed to reach the full population of independently owned firearm retailers in Washington State was conducted in late 2016. Survey items assessed business characteristics, beliefs and perceptions about suicide and its prevention, and willingness to engage in suicide prevention with customers. Assuming conservative standards, the completion rate was 22.4% (n=178). Descriptive analyses characterize the sample, and a series of logistic regressions identify the factors affecting retailers’ self-reported willingness to engage in four prevention behaviors.

Results: One quarter of surveyed firearm retailers train employees about the potential for customer suicides and only 5% had written guidelines on the subject. Six percent of retailers believed some of their customers may be at risk for suicide, and almost all (98%) underestimated the high proportion of firearm deaths attributable to suicide. Four retailers – 5% of those with a physical storefront – reported that a customer had either attempted or completed suicide in their store. The majority of respondents endorsed a willingness to learn about and engage in suicide prevention activities. Belief in the preventability of suicide and degree of perceived responsibility to intervene were found to be positively associated with a willingness to engage in each of the four prevention behaviors (p’s < .05). Self-assessed familiarity with warning signs of suicide was positively associated with a willingness to disseminate prevention information and to intervene with a customer if concerned about suicidality. Retail establishments who earn the majority of their profits from the sale of firearms were more likely to endorse a willingness to learn about suicide prevention and to intervene if concerned about a customer. Number of employees was negatively associated with willingness to disseminate prevention information with firearm purchases. Finally, stigma against discussing mental health was not found to be a significant predictor of any willingness outcome.

Implications:  These results show that firearm retailers in Washington State are largely willing to help prevent customer suicides, while pointing toward potential pathways for increasing willingness among those who are not. For example, educating retailers about the high prevalence of suicide among all firearm deaths may highlight the importance of their role in prevention and the relative risk among their customers. Education on warning signs may increase retailers’ willingness to identify and intervene with customers who may be at risk for suicide. Interventions that increase belief in the preventability of suicide and personal responsibility for prevention are needed to engage firearm retailers in suicide prevention.