Lethal Means Safety Interventions for Suicide Prevention

silhouette of two soldiers standing with sunset in background
U.S. Army photo by Sgt. Ryan M Gosselin

By Lisa M. Shank, Ph.D., MPH and Marija S. Kelber, Ph.D.
July 10, 2025

Suicide deaths are tragic events with profound impact on loved ones and communities of the deceased. There were 45,979 deaths by suicide in the United States in 2020.1 The most common methods of suicide included death by firearms, suffocation, and poisoning.1 In 2020, 384 active duty military members died by suicide. Similarly, the most common methods involved were firearms, suffocation, and drugs or alcohol.2 The DOD has invested considerable resources into suicide prevention and evaluation of interventions such as lethal means safety interventions for prevention of suicide.

What are lethal means safety interventions?

Lethal means are objects or situations that a person can use to hurt or kill themselves.3 Examples include medications, firearms, or bridges. Lethal means safety interventions make it more difficult for an individual in crisis to access a lethal object or situation, thereby reducing suicide attempts and/or deaths.3

Examples of interventions include:

  • Firearm safety information
  • Community distribution of free gun locks
  • Medication safe storage
  • “Anti-suicide” barriers on bridges
  • Reducing carbon monoxide emissions from cars
  • Lethal means safety counseling

What do we know about the effectiveness of lethal means safety interventions?

Some research shows specific types of safety interventions for some suicide methods can probably reduce suicide. However, these findings are not based on large, randomized studies. Therefore, it is difficult to understand the effectiveness of these interventions without such evidence. A recent review reported that lethal means counseling improved the safe storage of medications and/or firearms by civilians and National Guard members.4,5 However, there was no information about how effective it was at reducing suicide outcomes.4

Psychological Health Center of Excellence recently completed a systematic review to examine if interventions designed to change the availability of methods used in suicide were associated with reduced suicide deaths or attempts. We searched key research databases for longitudinal intervention studies in adult populations that had a comparator group. We included 36 studies that met our criteria. Most of the studies examined the impact of state firearm laws on suicide outcomes in the general population, such as laws requiring licenses to own firearms, comprehensive background checks to purchase firearms, or banning certain types of firearms.

Though the results were mixed, most studies showed that stricter state-level firearm regulations were associated with a small reduction in suicide deaths. Other interventions, including lethal means safety counseling and interventions targeting other methods, such as pesticide ingestion, had limited, mixed, and/or inconclusive findings across studies. No included studies examined a military sample; however, one study focused on veterans. This study reviewed medical records documentation of veterans and found that the completion and/or quality of lethal means assessment (as documented in the medical records) was not associated with future suicide attempts among veterans.6

Though the evidence in favor of lethal means safety interventions across all suicide methods is not overwhelming, lethal means safety interventions are routine care for individuals at risk for suicide. The Veterans Affairs/Department of Defense clinical practice guideline for managing suicide risk suggest reducing access to lethal means to reduce the risk of suicide by firearms, jumping, or medication overdose. However, these guidelines also note that the evidence for lethal means interventions is not strong.7 Therefore, future research should continue to conduct studies examining the impact of lethal means safety interventions for all suicide methods on suicide outcomes both on the individual level (e.g., lethal means counseling) and on the population level (e.g., state laws impacting availability of lethal means).

Resources

To learn more about lethal means safety and suicide prevention, visit:

For immediate help, reach out to: ·

Psychological Health Resource Center: 866-966-1020 or live chat available 24/7

References

  1. Ehlman, D. C., Yard, E., Stone, D. M., Jones, C. M., Mack, K. A. (2022). Changes in suicide rates — United States, 2019 and 2020. MMWR Morb Mortal Wkly, 71(8):306-312. doi:10.15585/mmwr.mm7108a5
  2. Department of Defense. (2020). Annual Suicide Report: Calendar Year 2020. https://www.dspo.mil/Portals/113/Documents/CY20%20Suicide%20Report/CY%202020%20Annual%20Suicide%20Report.pdf?ver=0OwlvDd-PJuA-igow5fBFA%3d%3d
  3. Barnard, L., Rowhani-Rahbar, A., Betz, M. E. (2021). Lethal means safety approaches for suicide prevention. Adv Psychiatry Behav Health, 1(1), 77-89. doi:10.1016/j.ypsc.2021.05.015
  4. Spitzer, E. G., Stearns-Yoder, K. A., Hoffberg, A.S., Bailey, H.M., Miller, C.J., Simonetti, J.A. A systematic review of lethal means safety counseling interventions: Impacts on safety behaviors and self-directed violence. Epidemiologic Reviews, 46(1), 1-22. https://doi.org/10.1093/epirev/mxae001
  5. Anestis, M. D., Bryan, C. J., Capron, D. W., Bryan, A. O. (2021). Lethal means counseling, distribution of cable locks, and safe firearm storage practices among the Mississippi National Guard: A factorial randomized controlled trial, 2018–2020. Am J Public Health, 111(2), 309-317. doi:10.2105/AJPH.2020.306019)
  6. Green, J. D., Kearns, J. C., Rosen, R. C., Keane, T. M., Marx, B. P. (2018). Evaluating the effectiveness of safety plans for military veterans: Do safety plans tailored to veteran characteristics decrease suicide risk? Behav Ther., 49(6), 931-938. doi:10.1016/j.beth.2017.11.005
  7. Department of Veterans Affairs/Department of Defense. (2024). VA/DOD Clinical practice guideline for assessment and management of patients at risk for suicide. (Version 3.0). https://www.healthquality.va.gov/guidelines/MH/srb/VADoD-CPG-Suicide-Risk-Full-CPG-2024_Final_508.pdf

Lisa M. Shank, Ph.D., MPH, is currently an assistant professor in the Medical & Clinical Psychology Department at Uniformed Services University of the Health Sciences. In her previous role, she was a contractor supporting Psychological Health Center of Excellence, Defense Health Agency. Her research focuses on the overlap between psychological and physical health, particularly in individuals in the military family.

Marija S. Kelber, Ph.D., is a research psychologist and a section chief for Evidence Synthesis and Dissemination at the Psychological Health Center of Excellence.

The views expressed in this blog post reflect the results of research conducted by the authors and do not necessarily reflect the official policy or position of the Defense Health Agency, Department of Defense, nor the U.S. Government.