ABSTRACT

U.S. suicide rates have risen every year over the past two decades with self-directed firearm use as the method accounting for the highest proportion of deaths. This pattern is particularly pronounced among veterans and members of the U.S. Armed Forces. The numerical burden of firearm-related suicide accompanied by characteristics of self-directed firearm injury have motivated the development of lethal means safety initiatives focused on firearms. Simultaneously, research has sought to characterize patterns of firearm ownership and use among veterans as well as optimal strategies for clinicians to deliver suicide prevention messages to firearm owners. Increasingly, findings from research have been understood as cultural factors that warrant greater attention to improve the quality of lethal means counseling. Here, we review and interpret selected research on cultural aspects of firearm ownership and suggest that cultural differences between health care practitioners and firearm owners may result in health care practitioners delivering clinical interventions that are broadly divergent from perspectives within the cultural frameworks of firearm owners. We follow by organizing these cultural factors into existing frameworks of cultural competency training as a basis for developing curriculum for health care practitioners to improve clinical care.

摘要

在过去的二十年里，美国的自杀率每年都在上升，而使用枪支是导致死亡比例最高的方法。这种模式在退伍军人和美国武装部队成员中尤为明显。枪支相关自杀的数字负担伴随着自我导向的枪支伤害的特征，推动了以枪支为重点的致命手段安全举措的发展。同时，研究试图描述退伍军人拥有和使用枪支的模式，以及临床医生向枪支拥有者传达预防自杀信息的最佳策略。越来越多的研究结果被理解为文化因素，需要更多地关注提高致命手段咨询的质量。这里，我们回顾和解释了关于枪支拥有者文化方面的选定研究，并建议医疗保健从业者和枪支拥有者之间的文化差异可能导致医疗保健从业者提供的临床干预措施与枪支拥有者的文化框架内的观点大相径庭。我们随后将这些文化因素组织到现有的文化能力培训框架中，作为为医疗保健从业者开发课程以改善临床护理的基础。