Using Financial Incentives to Increase Safe Storage of Firearms and Medications Among Veterans at Risk for Suicide.
Using Financial Incentives to Increase Safe Storage of Firearms and Medications Among Veterans at Risk for Suicide.
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利用经济激励措施增加有自杀风险的退伍军人的枪支和药物的安全储存。
DOI：
10.1176/appi.ps.20230043
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Simonetti,Joseph
中科院分区：
文献类型：
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作者：
Khazanov,Gabriela;Gordon,Michelle;Simonetti,Joseph
致编辑：枪支和中毒，通常是药物过量，是普通人群和美国退伍军人中大多数自杀死亡的原因。致命手段咨询（LMC）是一种基于证据的干预措施，临床医生鼓励患者限制他们使用致命的自杀手段（例如枪支，药物），但只有30%-60%的人在接受LMC后改变了他们的枪支或药物储存做法（2，3）。由于经济激励措施已被证明可以激励行为改变（4），我们研究了使用这种激励措施来增加有自杀风险的退伍军人在LMC后枪支和药物的安全储存的可接受性和可行性。我们对在过去6个月内报告过自杀想法的退伍军人进行了一项调查（哥伦比亚自杀严重程度评定量表[5]），并对2020年9月至2021年9月期间费城退伍军人事务医疗中心门诊行为健康机构的心理健康临床医生进行了调查。调查评估了对利用财政奖励激励安全火器或药物储存的干预措施的看法。评分范围从1（完全不同意）到5（完全同意），其中35人既不同意也不反对。预先确定的截止时间。3表示可接受。退伍军人是通过邮寄信件招募的，他们通过电话完成了调查，包括对自杀意念的评估。临床医生在电子邮件招募后匿名在线完成调查。467名退伍军人中有85人做出了回应（回应率为18%）。平均6SD年龄为50.4614。9例; 16%（N514）为女性，49%（N542）为黑人，27%（N523）为白色，12%（N510）为拉丁裔，12%（N510）为多种族或其他。大约三分之一（32%，N527）报告目前可以获得枪支（62%[N553]以前可以获得），65%（N555）报告目前可以获得可能有毒的药物。300名临床医生中有60名参与（应答率为20%）; 45%（N527）为心理学家，25%（N515）为精神科医生，12%（N57）为社会工作者，10%（N56）为护士，8%（N55）为其他临床医生;经验年限516。1612.2.退伍军人表示，他们认为可以接受礼品卡，以完成关于枪支安全储存选择的简短培训（3.6461）。41)或药物（3.8961. 35），或临时存放枪支以外的家庭（3.9861。36），在家里卸下和锁定枪支（3.7361。53），安全处置不需要的药物（4.4361。00），或锁定或从家里删除药物不需要在未来几天（3.9361。36）。重复测量方差分析的结果显示，丢弃不需要的药物被认为比其他选择更可接受（F55。02，df 55和415，p，0.001）。退伍军人表示，20 - 30美元的礼品卡将激励他们从事安全存储，尽管价值范围很广（完成关于储存选择的培训，中位数5 $20，四分位数间距[IQR] 5 $20，范围5 $1-$100;更安全地储存枪支，中位数5 $30，IQR 5 $30，范围5 $1-$2 500;更安全地储存药物，中位数5$30，IQR5$30，范围5$1-$5，000）。退伍军人表示愿意通过电话与临床医生确认枪支或药物储存的变化（4.3761。17），提供存储设施或锁定装置的图片（4.1461。32），或提供一个从存储设施的收据或一个关键的锁定装置（3.9961。38）。退伍军人不太愿意让临床医生通过与家人或信任的朋友沟通来确认变化（2.1961。56，F555。40，df 53和246，p，001）。临床医生表示，为退伍军人提供激励措施是可以接受的，也是可行的。
TO THE EDITOR: Firearms and poisoning, often by medication overdose, account for most suicide deaths among the general population and US veterans (1). Lethal means counseling (LMC) is an evidence-based intervention in which clinicians encourage patients to limit their access to lethal means of suicide (eg, firearms, medications), but only 30%–60% of individuals change their firearm or medication storage practices after receiving LMC (2, 3). Because financial incentives have been shown to motivate behavior change (4), we examined the acceptability and feasibility of using such incentives to increase safe storage of firearms and medications following LMC among veterans at risk for suicide. We fielded a survey to veterans who had reported suicidal ideation in the preceding 6 months (on the Columbia–Suicide Severity Rating Scale [5]) and to mental health clinicians from outpatient behavioral health settings in the Philadelphia Veterans Affairs Medical Center from September 2020 to September 2021. Surveys assessed perceptions of interventions utilizing financial incentives to motivate secure firearm or medication storage. Ratings ranged from 1, completely disagree, to 5, completely agree, where 35neither agree nor disagree. A predetermined cutoff of. 3 indicated acceptability. Veterans were recruited via mailed letters, and they completed surveys, including assessment of suicidal ideation, by phone. Clinicians completed surveys anonymously online after e-mail recruitment. Eighty-five of 467 veterans responded (18% response rate). Their mean6SD age was 50.4614. 9; 16%(N514) were women, 49%(N542) Black, 27%(N523) White, 12%(N510) Latinx, and 12%(N510) multiracial or other. About a third (32%, N527) reported current access to a firearm (62%[N553] previously had access), and 65%(N555) reported current access to medications that could be toxic. Sixty of 300 clinicians participated (20% response rate); 45%(N527) were psychologists, 25%(N515) psychiatrists, 12%(N57) social workers, 10%(N56) nurses, 8%(N55) other clinicians; years of experience516. 1612.2. Veterans indicated that they would find it acceptable to receive a gift card for completing a brief training about secure storage options for firearms (3.6461. 41) or medications (3.8961. 35), or for temporarily storing firearms outside of the home (3.9861. 36), unloading and locking firearms at home (3.7361. 53), safely disposing of unneeded medications (4.4361. 00), or locking or removing from the home medications not needed during the upcoming few days (3.9361. 36). Results from a repeated-measures analysis of variance showed that disposing of unneeded medications was considered more acceptable than the other options (F55. 02, df55 and 415, p, 0.001). Veterans stated that a $20–$30 gift card would motivate them to engage in safe storage, although values ranged widely (to complete a training about storage options, median5 $20, interquartile range [IQR] 5 $20, range5 $1–$100; store firearms more safely, median5 $30, IQR5 $30, range5 $1–$2,500; store medications more safely, median5 $30, IQR5 $30, range5 $1–$5,000).Veterans indicated willingness to confirm changes to their firearm or medication storage with clinicians by telephone (4.3761. 17), providing a picture of the storage facility or locking device (4.1461. 32), or providing a receipt from a storage facility or a key to a locking device (3.9961. 38). Veterans were less willing to have clinicians confirm changes by communicating with their family member or trusted friend (2.1961. 56, F555. 40, df53 and 246, p, 001). Clinicians indicated that providing veterans with incentives was acceptable and feasible …
来自两歧双歧杆菌的两种 β-N-乙酰氨基葡萄糖苷酶协同降解粘蛋白核心结构。
DOI：
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发表时间：
2021
期刊：
影响因子：
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作者：
高田紘翠;加藤紀彦;阪中幹祥;片山高嶺
通讯作者：
片山高嶺