Article Text

Download PDFPDF
SAFER brief community intervention: a primary suicide prevention strategy to improve firearm and medication storage behaviour
  1. Jennifer Paige Stuber1,
  2. Anne Massey2,
  3. Morgan Meadows1,
  4. Brett Bass1,
  5. Ali Rowhani-Rahbar3
  1. 1 Forefront Suicide Prevention, School of Social Work, University of Washington, Seattle, Washington, USA
  2. 2 Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
  3. 3 Department of Epidemiology, University of Washington, Harborview Injury Prevention & Research Center, Seattle, Washington, USA
  1. Correspondence to Dr Jennifer Paige Stuber, School of Social Work, University of Washington, Seattle, WA 98105, USA; jstuber{at}


Objective To determine if a brief intervention, called Signpost, Assess, Facts, Emotion, Recommend (SAFER), designed to motivate changes in behaviour to secure firearms and medications to prevent future suicide is feasible to implement in community-based settings such as gun shows, acceptable to participants at higher risk for suicide including veterans and men in the middles years (35–64) and improves firearm and medication locking behaviours.

Methods 1175 people received SAFER over a 12-month period at 18 gun shows and community events in 2019 and completed a preassessment measuring firearms ownership, storage practices, knowledge about suicide as the leading type of firearm fatality and attitudes about suicide prevention. 372 responded to a brief postassessment using comparable measures.

Results 85% of participants reported keeping firearms at home. 43.7% reported current or prior military service. 53.2% were males between the ages of 35 and 64. Among those who responded to the postassessment, 61% of participants reported SAFER to be highly valuable. Safe firearms storage improved among participants who completed the preassessment and postassessment (51.2% pre, 66.0% post; p<0.01) as did safe medication storage (14.8% pre, 21.6% post; p=0.01). Knowledge that most firearm fatalities are suicides (33.4% pre, 45.8% post; p<0.01) also improved.

Conclusions It is feasible, acceptable and effective to reach groups at elevated risk for suicide using a brief intervention strategy in unconventional settings. Community-based interventions to improve safe storage motivated by suicide prevention messaging should be prioritised because men in the middle years are less likely to use mental health services.

  • suicide/selfharm
  • health education
  • legislation
  • safe community
  • firearm

Data availability statement

Data are available on reasonable request. Data are deidentified participant data available from MM at

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available on reasonable request. Data are deidentified participant data available from MM at

View Full Text


  • Contributors JPS drafted the manuscript and led the analysis. AM conducted the analysis and revised the manuscript providing important intellectual content. BB made a substantial contribution to the conception and design of the work. MM collected the data, completed some of the analysis and provided final in-depth feedback. AR-R provided feedback on the analysis and manuscript and provided substantial contributions to the conception of the work. All authors contributed to the intellectual content of the work.

  • Funding This evaluation was funded by the Washington State Legislature and Boeing Global Engagement.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.