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Abstract
Background Extreme risk protection order (ERPO) laws may be effective tools for preventing firearm suicide. Oregon’s ERPO law allows family/household members or law enforcement officers (LEOs) to petition a civil court for an order to temporarily restrict a person’s access to firearms when at imminent risk of harming themselves or others. We analysed Oregon’s ERPO petitions to describe the law’s utilisation for the potential prevention of suicide.
Methods ERPO petitions were obtained from the Oregon Judicial Department. Data were abstracted for the 6-year period after the law took effect (2018–2023). A 20% random sample of records was double-coded. Inter-rater agreement was >80% for key variables. Descriptive analyses were conducted to examine petitions citing suicide risk; cross-tabulations compared suicide-related petitions to those unrelated to suicide.
Results There were 835 petitions filed and 650 (78%) initially granted. Suicide risk was identified in 516 petitions (62%), 421 of which were initially granted (82%). Suicide-related petitions were more likely to be granted than non-suicide-related petitions (72%; p=0.001). Threats to others were also cited in 80% of suicide-related petitions. LEOs filed 60% and family/household members filed 29% of suicide-related petitions. Concerns cited in suicide-related petitions included substance use (56%) and mental health diagnoses (27%). Respondents were hospitalised or referred for services in 41% of suicide-related petitions.
Conclusions Oregon’s ERPO law is being used to address firearm suicide risk, but implementation gaps may exist, including missed opportunities for healthcare or other services. Further research examining barriers and facilitators to ERPO use for suicide prevention is needed.
- Firearm
- Suicide/Self?Harm
- Policy
- Public Health
- Cross Sectional Study
Data availability statement
Data are available upon reasonable request.
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WHAT IS ALREADY KNOWN ON THIS TOPIC
Population-level research on extreme risk protection order (ERPO) laws supports the use of ERPOs as a suicide prevention tool, with a recent four-state study estimating that one suicide was prevented for every 17–23 ERPOs filed.
WHAT THIS STUDY ADDS
This cross-sectional analysis of 835 ERPO petitions provides insight into how Oregon’s ERPO law is being used to address firearm suicide risk. Our study indicates that the law is being used to try to prevent suicide, but greater attention to connecting those at risk with needed mental healthcare or other services may be needed.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
This work improves knowledge of the implementation and use of Oregon’s ERPO law as a tool for firearm suicide prevention and suggests areas for improvement to prioritise respondent safety and well-being. Future research should examine barriers and facilitators to ERPO implementation to reduce suicide risk.
Introduction
Firearm suicide is a growing problem in the USA, comprising 56% of all firearm-related deaths in 2022.1 Access to firearms more than triples the odds of suicide, and nearly 90% of firearm suicide attempts are lethal.2 3 Preventing firearm access during high-risk periods may prevent suicide attempts and deaths.4
Extreme risk protection orders (ERPOs) provide a mechanism for temporarily restricting individuals’ access to firearms when at imminent risk of harming themselves or others through a civil court order.5 ERPO laws exist in 21 states and the District of Columbia; provisions vary across states.5
In Oregon, family/household members and law enforcement officers (LEOs) are eligible petitioners.6 If the ERPO is granted at an initial ex parte hearing (attended only by the petitioner), the respondent (the individual against whom the ERPO is filed) must surrender all deadly weapons within 24 hours of service and cannot purchase firearms for the order duration. Respondents can request a hearing to contest orders within 30 days of service.
Research has suggested ERPOs may be effective tools for preventing firearm suicide, with a recent four-state study estimating that one suicide was prevented for every 17–23 orders issued.7–10 Additionally, studies on risk-based laws in Indiana and Connecticut have reported ERPO-related reductions in population-level firearm suicide rates.7 Still, little is known about utilisation of ERPOs for suicide prevention, or how ERPOs addressing suicide risks may differ from ERPOs unrelated to suicide. To address this knowledge gap, we examined all petitions filed in Oregon (where the 2022 firearm suicide rate was 28% greater than the national rate) from 2018 to 2023, comparing petitions with and without risk of suicide.1
Methods
Data abstraction
Court records for Oregon ERPO petitions filed from 2018 to 2023 were accessed through the Oregon Judicial Case Information Network. Using a comprehensive data abstraction form and coding manual, we abstracted petition characteristics and outcomes, petitioner and respondent characteristics, threats and concerns cited in petitions and co-occurring interventions. For full details, see online supplemental table 1 and Rakshe et al.11 A 20% simple random sample of records was double-coded; inter-rater agreement was >80% for all key variables.
Supplemental material
Statistical analysis
We used descriptive statistics to examine ERPO use by year, respondent characteristics, concerns cited and outcomes. Fisher’s exact test was used to compare petition characteristics of suicide-related ERPOs to non-suicide-related ERPOs for all categorical variables. Statistical testing for the race variable compared the largest race category (white) to the sum of all other race categories (excluding missing/unknown values). For the petitioner relationship to respondent, only eligible petitioner categories were compared (LEO and family/household member). The Wilcoxon rank sum test was used for comparing the age variable. P values ≤0.05 were considered significant. Petition characteristics by risk type were also compared for only granted ERPOs (online supplemental table 2).
County rates were calculated as the number of suicide-related ERPOs filed per 100 000 county residents, using population estimates from the 2020 US Census.12 County-level rural/urban designations were based on the Federal Office of Rural Health Policy’s designations.13 Analyses were performed with R V.4.2.2.14
Results
Petitions and outcomes
From 2018 to 2023, 835 ERPO petitions were filed; 78% were granted at ex parte hearings. The risk of suicide was cited in 516 petitions (62%). In 80% of suicide-related petitions, threats to others were also cited (table 1). Numbers of petitions filed annually increased over time, both for overall petitions and those related to suicide (figure 1).
Number of ERPO petitions filed in Oregon from 2018 to 2023, by year and by type of risk cited in the petition. ERPO, extreme risk protection order.
Characteristics of ERPO petitions filed in Oregon, 2018–2023, by type of risk cited in the petition
Among the 516 suicide-related petitions, 421 (82%) were granted at ex parte hearings. Suicide-related petitions were more likely to be granted than those unrelated to suicide (72%; p=0.001). Proportions of suicide-related petitions granted were similar each year (figure 2).
Number of suicide-related ERPO petitions filed in Oregon from 2018 to 2023, by year and by outcome at the ex parte hearing. *One petition was neither granted nor denied at the initial ex parte hearing (eg, case dismissed without prejudice). ERPO, extreme risk protection order.
Suicide-related petitions and petitions unrelated to suicide were predominantly filed in urban counties (81% and 76%, respectively). At least one suicide-related ERPO was filed in 28 of Oregon’s 36 counties (78%). Rates of petitioning varied widely among counties with at least one suicide-related ERPO, from 4 to 98 per 100 000 county residents, with a median rate of 11 suicide-related ERPOs filed per 100 000 county residents.
Petitioner and respondent characteristics
Most suicide-related petitions were filed by LEOs (60%), followed by family/household members (29%; table 1). The proportion of family/household member petitioners was higher among suicide-related petitions (29%) than among those unrelated to suicide (20%; p=0.017). Among suicide-related petitions, LEO petitioners had the highest approval rate (96% granted), followed by family/household members (71%). Small numbers of non-eligible petitioners had their petitions granted, including ex-spouses/ex-intimate partners, extended family and healthcare providers.
Respondent sex, race and age were available in 98%, 71% and 83% of suicide-related petitions, respectively. Among suicide-related petitions with non-missing demographic data, most respondents were male (81%) and white (96%), with a median age of 37 years. Respondents in suicide-related petitions tended to be slightly younger (mean age: 41 years) than those in non-suicide-related petitions (mean age: 45 years; p=0.001; table 1).
Concerns cited
Reports of intimate partner violence were more common among suicide-related petitions (25%) than petitions unrelated to suicide (19%; p=0.033; table 1). (We observed that respondents sometimes threatened suicide in a manner consistent with emotional abuse—for example, threatening suicide if their partner leaves them—in petitions also citing intimate partner violence concerns.) Suicide-related petitions mentioned concerns of substance use (56%), including alcohol use (31%); mental health diagnoses (27%) and mental health concerns (41%, including paranoia, delusions, hallucinations and erratic behaviour). Most of these concerns were more common in suicide-related petitions than petitions unrelated to suicide, apart from most threats of violence towards others (ie, assault, mass violence, risk to school or college campuses, risk of harm to children) and mental health concerns (table 1).
Co-occurring interventions
Co-occurring interventions used to respond to the crisis around the time of the filing of suicide-related petitions sometimes included arrests (19%), peace officer mental health holds (16%) and hospitalisations or referrals for services (41%). Suicide-related petitions were more likely to report the respondent being hospitalised or referred for services in response to the precipitating event compared with those unrelated to suicide (25%; p<0.001). Hospitalisation/service referrals were mentioned in 25% of suicide-related ERPOs that cited domestic violence, 39% that cited substance use, 49% that cited mental health diagnoses and 43% that cited mental health concerns.
Weapons access and surrender
Current access to deadly weapons was indicated in 81% of both suicide-related and non-suicide-related ERPOs. Formal documentation of weapons surrender was present in 29% of suicide-related ERPOs and 33% of non-suicide-related ERPOs.
Discussion
From 2018 to 2023, 835 ERPO petitions were filed in Oregon, of which 516 (62%) cited a history of suicide threats or attempts. This proportion was similar to that observed in studies in Washington and Connecticut.8 15 While a large proportion of petitions cited the risk of suicide, 80% of these suicide-related ERPOs also involved threats towards others. Fewer petitions exclusively targeted risks of suicide, potentially indicating a need for increased public education on ERPOs as a suicide prevention tool, a need previously identified in an analysis of media reporting on ERPOs.16
Suicide-related petitions were more likely to cite concerns of alcohol and substance use and mental health diagnoses than petitions unrelated to suicide. Alcohol use is associated with significantly greater risk of suicide generally, of firearm suicide specifically, and of other risk factors for firearm suicide such as unsecured firearm storage.17–19 Studies have found greater associations of diagnosed mental health conditions with non-firearm suicide than with firearm suicide, but mental health diagnoses remain significant risk factors for suicide, suggesting that ERPOs may be important touchpoints for connection to needed mental health services.20 Respondents at risk for suicide were more likely to be hospitalised or referred for services than other respondents, but these interventions were still infrequent and typically occurred before ERPO filing, rather than as part of the ERPO process itself. Other states have used ERPOs to connect individuals to needed services, including Washington, where mental health evaluations were ordered by courts as part of the ERPO in 30% of cases.15 The ERPO process could serve as a key entry point for individuals to be connected to services, but court records do not indicate that this is occurring consistently in Oregon.
Limitations of this study include the subjectivity of coding, variability in levels of detail provided in ERPO court records, missing data for some key variables and limited generalisability due to the focus on one state. However, this 6-year study period is one of the longest analyses of ERPOs to date, and the comparison of cases with and without suicide threats identifies distinguishing characteristics of these cases, which may inform the use of ERPOs for suicide prevention.
Conclusions
This analysis of suicide-related petitions indicates that Oregon’s ERPO law is being used to try to prevent suicide, but implementation gaps exist, including missed opportunities for service connections. Further research should examine barriers and facilitators to ERPO use for suicide prevention, best practices for connecting respondents to services, and individual health and safety outcomes among respondents.
Data availability statement
Data are available upon reasonable request.
Ethics statements
Patient consent for publication
Ethics approval
This study was approved by the Oregon Health and Science University Institutional Review Board.
Acknowledgments
Parts of this work were previously presented at the Society for Advancement of Violence and Injury Research (SAVIR) Annual Meeting in April 2024.
References
Footnotes
Contributors All authors (RV, RT, SR, SD and KC) took part in the study concept and design, acquisition of the data, analysis and interpretation of the data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical expertise and final approval of the manuscript. SD and KC were responsible for the acquisition of funding for this study. All authors agree to be accountable for all aspects of the work. KC is the guarantor of the study.
Funding This work was funded in part by the Silver Family Innovation Fund through Oregon Health & Science University.
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.