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Seattle-Denver Center of Innovation (COIN)

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COIN Investigators & Staff

COIN Investigators


Joseph A Simonetti, MD, MPH
Title: Core Investigator, Career Development Awardee
Associate Professor, University of Colorado School of Medicine
Location: Denver
University of Colorado webpage
Rocky Mountain MIRECC
Dr. Simonetti is a physician at the Rocky Mountain Regional VA Medical Center and investigator with the Denver-Seattle COIN and Rocky Mountain MIRECC for Suicide Prevention. His research focuses on improving access to high quality care among U.S. veterans and developing patient-centered firearm safety interventions for individuals at risk of suicide. As an educator, he works locally and nationally to support VA and community-based clinicians in delivering evidence-based and culturally competent lethal means safety counseling to at-risk Veterans.
In response to the challenges faced by many of our nation’s veterans stemming in part from their military service, the VA has developed one of the most advanced mental health treatment and suicide prevention systems in the world. Working here gives me the opportunity to work with and and learn from true experts in health services and mental health research.
My hope is that this line of work will contribute to a change in dialogue about the risks of firearm access among veterans and within their households, and for those who are at risk of firearm injury, reduce the barriers and stigma related to adopting protective firearm behaviors.

Research Interests


Dr. Joe Simonetti’s work is to develop Veteran-centered approaches to reduce firearm suicide risk. Firearms are the most lethal method of suicide, resulting in death almost 90% of the time when they are used. Veterans use firearms more often than any other method, about 70% for men and 50% for women.

The focus is mostly on clinical interventions such as identifying those most at risk of suicide and reducing the lethal means used in suicide. In the VA identifying risk is now exploring whether factors in an individual’s medical record can be used identify if a person is at an elevated risk. This model uses artificial intelligence to explore medical records for patterns or hints that might identify a Veteran in need of intervention.

Lethal means safety (LMS) is the identification of ways to harm yourself and creating distance between you and those means. Suicide prevention research understands that creating time and distance between a person and the method of harming themselves saves lives. LMS is the process for creating that time and distance.

Identifying who is most at risk of suicide and lethal means safety are mostly clinical approaches to suicide prevention.

Dr. Simonetti is also creating community partnerships and engaging the community in reducing firearm suicide risk. Suicide is a topic with many myths and one we don’t discuss enough, and talking about firearms can sometimes be challenging. Dr. Simonetti’s work understands we must discuss both if we are going to reduce Veteran suicide risk.

See Dr. Simonetti's Dimensions profile that includes: publications, grants, datasets, patents and clinical trials

Below are projects that have grown out of the work Dr. Simonetti and his collaborators have done:

Lethal Means Safety & Suicide Prevention
This website created by Rocky Mountain Mental Illness Research, Education and Clinical Center (RMIREC) provides the evidence behind lethal means safety and resources for clinicians, caregivers and policy-makers.
Visit the Lethal Means Safety & Suicide Prevention website
The Firearm Life Plan
The Firearm Life Plan site, and its associated resources, was developed to help people think about important questions related to their firearms and protect their families from the burden of making difficult decisions without guidance. A Firearm Life Plan is a voluntary, personal plan made between a firearm owner and those they trust.
Visit the The Firearm Life Plan website
Everything you’ll need to make a plan for your firearms that’s right for you and those you trust.
Download the full toolkit
Injury & Violence Prevention Center
The Injury & Violence Prevention Center is a collaborative initiative of the Colorado School of Public Health and the University of Colorado School of Medicine. They aim to prevent and reduce injury and its outcomes in Colorado, the region, and throughout the world as a function of high-quality research and effective practice.
Visit the Injury & Violence Prevention Center website
This toolkit provides practical information about voluntary, temporary firearm storage, including the rationale for offering this type of storage and logistics in developing a storage program or a map of storage options.
Download the toolkit

The following images visualize Dr. Simonetti's work. The word cloud is drawn from publication titles. The research collaboration map shows research relationships (click the image to enlarge):

Dr. Simonetti's publication titles indicate their primary work is firearm safety
Word cloud from pub titles
Dr. Simonetti's collaborations are primarily from the University of Colorado
Research collaboration map
The following research fields have been used to summarize Dr. Simonetti's publications and grants.
Publications Grants
Clinical Research Mental Health
Behavioral and Social Science Firearm Safety
Prevention Suicide Prevention
Suicide Clinical Research
Mental Health Comparative Effectiveness Research
Suicide Prevention Prevention
Health Services  
Brain Disorders  
Injury (total) Accidents/Adverse Effects  

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Grants & Funding

Incentivizing Lethal Means Safety Among Veterans at Risk for Suicide

This study seeks to test the feasibility, acceptability, and preliminary efficacy of using incentives-based interventions to motivate changes in firearm storage practices among veterans with elevated suicide risk
Funder: Veterans Affairs, HSR

Protective Environments: Military Community Engagement to Prevent Firearm-Related Violence

The aim of this expansion project is to develop a partner network of civilian firearm ranges/retailers near Buckley Space Force Base, and up to five additional military installations in the United States, that will provide education, outreach, and firearm secure storage options to the local military community.
Funder: Department of Defense

Understanding reasons for recent firearm purchasing among Black Americans to inform lethal means safety counseling

The aim of this pilot study is to explore perspectives on gun purchasing and ownership among Black Americans who recently acquired a firearm.
Funder: University of Pennsylvania INSPIRE Center

Colorado Office of Gun Violence Prevention Resource Bank Implementation and State-Academic Partnership Development

The goal of this project is to support the launch and maintenance of a resource bank as a repository for data, research, and statistical information regarding firearm injuries and deaths, and their prevention, in Colorado.
Funder: Colorado Department of Public Health and Environment

Developing artificial intelligence methods to identify firearm and substance use suicide risk factors in the VHA Electronic Medical Record (EMR)

The aim of this study is to use natural language processing and machine learning methods to identify important suicide risk factors located in free-text EMR entries.
Funder: Veterans Affairs, Office of Mental Health and Suicide Prevention

Involving Concerned Significant Others in Firearms Safety: Development and Pilot Test of a New Intervention to Prevent Suicide in Firearm Owners

The aim of this work is to adapt firearm safety intervention by incorporating support from significant others.
Funder: Veterans Affairs, Suicide Prevention Impact Network (SPRINT) Pilot Award

Development of a brief, motivational interviewing intervention manual for lethal means safety counseling for implementation within Primary Care and Primary Care Mental Health Integration

This study will use a mixed-methods approach to engage patient, clinical, and operational stakeholders to develop a motivational interviewing manual to facilitate the delivery of lethal means safety counseling in VA PCMHI settings.
Funder: Veterans Affairs, Suicide Prevention Impact Network (SPRINT) Pilot Award

Development and Testing of a Veteran-Centered Lethal Means Safety Suicide Prevention Intervention

Role: PI
Seventeen United States Veterans die by suicide each day. Nearly three-fourths of those Veterans die from firearm injury or poisoning, and many seek care in VA Emergency Departments (ED) before suicide attempts.
In 2019, the VA began screening all Veterans seeking ED care for increased suicide risk. Recommended are interventions promoting firearm and medication safety for Veterans identified as at-risk.
Our work will develop and test such an intervention for Veterans who seek care in VA EDs. We will interview at-risk Veterans who recently sought VA ED care to identify factors relevant to developing the intervention and work with Veterans and VA healthcare staff to develop and test the intervention.
Our safety intervention for Veterans with increased suicide risk is consistent with the VA 2018-2028 National Suicide Prevention Strategy, priority on preventing Veteran suicides and a focus on delivering Veteran-centered care.
Funder: Veterans Affairs
NIH website

Acceptability and Feasibility of a Peer-to-Peer Firearm-Specific Means Safety Intervention

This study aims to determine the feasibility and acceptability of a veteran-to-veteran firearm safety suicide prevention intervention.
Funder: Veterans Affairs, Office of Research and Development

Decision making among older adults: "Firearm retirement"

Goals: To: (1) explore diverse stakeholder perspectives to develop a conceptual framework of firearm retirement and compare emerging concepts/constructs to theoretical frameworks informing driving retirement; and (2) develop a culturally competent prototype intervention.
Funder: National Institute on Aging

Perspectives of female veterans, VHA providers, and family members on preventing firearm-inflicted suicides among female veterans

This study seeks to explore female Veterans’ perspectives regarding firearm suicide, the perspectives of their family, and perspectives of their mental health and primary care providers.
Funder: Veterans Affairs, HSR

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Recent Publications


Reis DJ, Kinney AR, Forster JE, Stearns-Yoder KA, Kittel JA, Wood AE, Oslin DW, Brenner LA, Simonetti JA. Longitudinal invariance of the Patient Health Questionnaire-9 among patients receiving pharmacotherapy for major depressive disorder: A secondary analysis of clinical trial data. Psychol Assess. 2024 May 16. doi: 10.1037/pas0001317. Epub ahead of print.
PMID: 38753374

Khazanov G, Spitzer E, Thomas S, Brenner LA, Simonetti JA. Financial barriers and facilitators to secure firearm and medication storage among veterans with elevated suicide risk: a qualitative study. Inj Prev. 2024 May 9:ip-2024-045232. doi: 10.1136/ip-2024-045232. Epub ahead of print.
PMID: 38724234

Khazanov GK, Keddem S, Hoskins K, Wortzel HS, Simonetti JA. Increasing the Acceptability of Lethal Means Safety Counseling for Firearms: Tips and Scripts. J Psychiatr Pract. 2024 Mar 1;30(2):139-146. doi: 10.1097/PRA.0000000000000773.
PMID: 38526402

Spitzer EG, Stearns-Yoder KA, Hoffberg AS, Bailey HM, Miller CJ, Simonetti JA. A Systematic Review of Lethal Means Safety Counseling Interventions: Impacts on Safety Behaviors and Self-Directed Violence. Epidemiol Rev. 2024 Feb 7:mxae001. doi: 10.1093/epirev/mxae001. Epub ahead of print.
PMID: 38324739

Hoisington AJ, Stearns-Yoder KA, Stamper CE, Simonetti JA, Oslin DW, Brenner LA. Longitudinal Influence of Prescribed Antidepressants on Fecal and Oral Microbiomes Among Veterans With Major Depressive Disorder. J Neuropsychiatry Clin Neurosci. 2024 Jan 23:appineuropsych20220221. doi: 10.1176/appi.neuropsych.20220221. Epub ahead of print.
PMID: 38258376


Polzer ER, Holliday R, Rohs CM, Thomas SM, Miller CN, Simonetti JA, Brenner LA, Monteith LL. Women Veterans' perspectives, experiences, and preferences for firearm lethal means counseling discussions. PLoS One. 2023 Dec 6;18(12):e0295042. doi: 10.1371/journal.pone.0295042. PMCID: PMC10699600.
PMID: 38055694

Wortzel HS, Simonetti JA, Knoepke CE, Simpson JR, Brar L, Westmoreland P, Matarazzo BB. Extreme Risk Protection Orders: Legislative Intent and Clinician Guidance. J Psychiatr Pract. 2023 Nov 1;29(6):480-488. doi: 10.1097/PRA.0000000000000749.
PMID: 37948173

Simonetti JA, Holliday R, Mignogna J, Thomas S, Smith A, Betz M, Brenner LA, Sayre G. Patients' Perspectives on Medication-Related Suicide Prevention Interventions Delivered in Emergency Settings. Psychiatr Serv. 2023 Nov 7:appips20230178. doi: 10.1176/ Epub ahead of print.
PMID: 37933134

Polzer ER, Rohs CM, Thomas SM, Holliday R, Miller CN, Simonetti JA, Iverson KM, Brenner LA, Monteith LL. Women Veterans' experiences discussing household firearms with their intimate partners: collaborative, devalued, and deferential relational types. Inj Epidemiol. 2023 Jul 31;10(1):39. doi: 10.1186/s40621-023-00452-7. PMCID: PMC10391848.
PMID: 37525290

Aunon FM, Azrael D, Simonetti JA, Miller M. Beliefs Among Veteran Firearm Owners Regarding Whether Clinicians Should Discuss Firearm Safety With Patients. JAMA Netw Open. 2023 Jun 1;6(6):e2321219. doi: 10.1001/jamanetworkopen.2023.21219. PMCID: PMC10311384.
PMID: 37382951

Betz ME, Simonetti JA. Approaches to Prevention of Firearm Violence-Reply. JAMA. 2023 Feb 14;329(6):513-514. doi: 10.1001/jama.2022.21865.
PMID: 36786794

Monteith LL, Miller CN, Polzer E, Holliday R, Hoffmire CA, Iglesias CD, Schneider AL, Brenner LA, Simonetti JA. "Feel the need to prepare for Armageddon even though I do not believe it will happen": Women Veterans' Firearm Beliefs and Behaviors during the COVID-19 Pandemic, Associations with Military Sexual Assault and Posttraumatic Stress Disorder Symptoms. PLoS One. 2023 Feb 10;18(2):e0280431. doi: 10.1371/journal.pone.0280431. PMCID: PMC9917279.
PMID: 36763646

Wortzel HS, Simonetti JA, Oslin DW, Hermes E, Matarazzo BB. Lithium Use for Suicide Prevention, Revisited. J Psychiatr Pract. 2023 Jan 1;29(1):51-57. doi: 10.1097/PRA.0000000000000680.
PMID: 36649553


Prater LC, Simonetti JA, Knoepke CE, Polzer ER, Nearing KA, Lee T, Betz ME. Older adults and planning for firearm safety: A qualitative study of healthcare providers. J Am Geriatr Soc. 2022 Dec 22. doi: 10.1111/jgs.18188. Epub ahead of print.
PMID: 36550590

Monteith LL, Kinney AR, Holliday R, Miller C, Schneider AL, Hoffmire CA, Simonetti JA, Brenner LA, Forster JE. Associations between deployment experiences, safety-related beliefs, and firearm ownership among women Veterans. J Psychiatr Res. 2022 Nov 14;157:72-81. doi: 10.1016/j.jpsychires.2022.11.004. Epub ahead of print.
PMID: 36442409

Betz ME, Polzer ER, Knoepke CE, Prater LC, Simonetti JA, Lee TM, Meador LE, Nearing KA. Cars, Guns, Aging, and "Giving Up the Keys". Gerontologist. 2022 Nov 16:gnac142. doi: 10.1093/geront/gnac142. Epub ahead of print.
PMID: 36383376

Khazanov GK, Keddem S, Hoskins K, Myhre K, Sullivan S, Mitchell E, Holliman BD, Landes SJ, Simonetti J. Stakeholder perceptions of lethal means safety counseling: A qualitative systematic review. Front Psychiatry. 2022 Oct 20;13:993415. doi: 10.3389/fpsyt.2022.993415. PMCID: PMC9634731.
PMID: 36339871

Betz ME, Thomas AC, Simonetti JA. Firearms, Suicide, and Approaches for Prevention. JAMA. 2022 Sep 27;328(12):1179-1180. doi: 10.1001/jama.2022.16663.
PMID: 36166015

Simonetti JA, Azrael D, Zhang W, Miller M. Receipt of clinician-delivered firearm safety counseling among U.S. Veterans: Results from a 2019 national survey. Suicide Life Threat Behav. 2022 Aug 4. doi: 10.1111/sltb.12906. Epub ahead of print.
PMID: 35924483

Oslin DW, Lynch KG, Shih MC, Ingram EP, Wray LO, Chapman SR, Kranzler HR, Gelernter J, Pyne JM, Stone A, DuVall SL, Lehmann LS, Thase ME; PRIME Care Research Group, Aslam M, Batki SL, Bjork JM, Blow FC, Brenner LA, Chen P, Desai S, Dieperink EW, Fears SC, Fuller MA, Goodman CS, Graham DP, Haas GL, Hamner MB, Helstrom AW, Hurley RA, Icardi MS, Jurjus GJ, Kilbourne AM, Kreyenbuhl J, Lache DJ, Lieske SP, Lynch JA, Meyer LJ, Montalvo C, Muralidhar S, Ostacher MJ, Paschall GY, Pfeiffer PN, Prieto S, Przygodzki RM, Ranganathan M, Rodriguez-Suarez MM, Roggenkamp H, Schichman SA, Schneeweis JS, Simonetti JA, Steinhauer SR, Suppes T, Umbert MA, Vassy JL, Voora D, Wiechers IR, Wood AE. Effect of Pharmacogenomic Testing for Drug-Gene Interactions on Medication Selection and Remission of Symptoms in Major Depressive Disorder: The PRIME Care Randomized Clinical Trial. JAMA. 2022 Jul 12;328(2):151-161. doi: 10.1001/jama.2022.9805.
PMID: 35819423

Spark TL, Cogan CM, Monteith LL, Simonetti JA. Firearm Lethal Means Counseling Among Women: Clinical and Research Considerations and a Call to Action. Curr Treat Options Psychiatry. 2022 Jun 30:1-11. doi: 10.1007/s40501-022-00273-3. Epub ahead of print. PMCID: PMC9247955.
PMID: 35791313

Wortzel HS, Simonetti JA, Ryan AT, Matarazzo BB. Firearm Injury Prevention and Extreme Risk Protection Orders. J Psychiatr Pract. 2022 May 1;28(3):240-243. doi: 10.1097/PRA.0000000000000631.
PMID: 35511101

Simonetti JA, Azrael D, Zhang W, Miller M. Perspectives on clinician-delivered firearm safety counseling during routine care: Results of a national survey. Prev Med. 2022 Apr 7:107039. doi: 10.1016/j.ypmed.2022.107039. Epub ahead of print.
PMID: 35398367

Simonetti JA, Anderson ML. When the messenger affects the message: Trustworthiness in the context of COVID vaccination. J Hosp Med. 2022 Feb 26:10.1002/jhm.12803. doi: 10.1002/jhm.12803. Epub ahead of print. PMCID: PMC9088351.
PMID: 35535927

Dobscha SK, Clark KD, Karras E, Simonetti JA, Newell S, Kenyon EA, Elliott V, Boster J, Gerrity M. Development and Preliminary Evaluation of an Education Program for Primary Care Teams on Discussing Firearms Storage Safety with Veterans. J Med Educ Curric Dev. 2022 Feb 14;9:23821205221077647. doi: 10.1177/23821205221077647. PMCID: PMC8851949.
PMID: 35187264

Leonard C, Kenney RR, Lee M, Greene P, Whittington M, Kirsh S, Ho PM, Sayre G, Simonetti J. Common Ground: Primary Care and Specialty Clinicians' Perceptions of E-Consults in the Veterans Health Administration. Fed Pract. 2022 Jan;39(1):42-47b. doi: 10.12788/fp.0214. Epub 2022 Jan 12. PMCID: PMC8849031.
PMID: 35185320



Simonetti JA, Wortzel HS, Matarazzo BB. Therapeutic Risk Management and Firearm-related Lethal Means Safety. J Psychiatr Pract. 2021 Nov 5;27(6):456-465. doi: 10.1097/PRA.0000000000000586.

PMID: 34768269

Clark KD, Newell S, Kenyon EA, Karras E, Simonetti JA, Gerrity M, Dobscha SK. Firearms storage safety discussions in VA primary care: Staff perspectives. Gen Hosp Psychiatry. 2021 Jul 22;72:96-101. doi: 10.1016/j.genhosppsych.2021.07.007. Epub ahead of print.

PMID: 34416678

Hoyt T, Holliday R, Simonetti JA, Monteith LL. Firearm Lethal Means Safety with Military Personnel and Veterans: Overcoming Barriers using a Collaborative Approach. Prof Psychol Res Pr. 2021 Aug;52(4):387-395. doi: 10.1037/pro0000372. Epub 2021 May 20. PMCID: PMC8375272.

PMID: 34421193

Hoops K, Fahimi J, Khoeur L, Studenmund C, Barber C, Barnhorst A, Betz ME, Crifasi CK, Davis JA, Dewispelaere W, Fisher L, Howard PK, Ketterer A, Marcolini E, Nestadt PS, Rozel J, Simonetti JA, Spitzer S, Victoroff M, Williams BH, Howley L, Ranney ML. Consensus-Driven Priorities for Firearm Injury Education Among Medical Professionals. Acad Med. 2021 Jul 6. doi: 10.1097/ACM.0000000000004226. Epub ahead of print.

PMID: 34232149

Newell S, Kenyon E, Clark KD, Elliott V, Rynerson A, Gerrity MS, Karras E, Simonetti JA, Dobscha SK. Veterans Are Agreeable to Discussions About Firearms Safety in Primary Care. J Am Board Fam Med. 2021 Mar-Apr;34(2):338-345. doi: 10.3122/jabfm.2021.02.200261.

PMID: 33833002

Dobscha SK, Clark KD, Newell S, Kenyon EA, Karras E, Simonetti JA, Gerrity M. Strategies for Discussing Firearms Storage Safety in Primary Care: Veteran Perspectives. J Gen Intern Med. 2021 Jan 26. doi: 10.1007/s11606-020-06412-x. Epub ahead of print.

PMID: 33501537

Whittington MD, Ho PM, Kirsh SR, Kenney RR, Todd-Stenberg J, Au DH, Simonetti J. Cost savings associated with electronic specialty consultations. Am J Manag Care. 2021 Jan 1;27(1):e16-e23. doi: 10.37765/ajmc.2021.88579.

PMID: 33471464



Simonetti JA, Clinton WL, Taylor L, Mori A, Fihn SD, Helfrich CD, Nelson K. The impact of survey nonresponse on estimates of healthcare employee burnout. Healthc (Amst). 2020 Sep;8(3):100451. doi: 10.1016/j.hjdsi.2020.100451. Epub 2020 Aug 2.

PMID: 32919589

Simonetti JA. Active Shooter Safety Drills and US Students-Should We Take a Step Back?. JAMA Pediatr. 2020 Aug 31. doi: 10.1001/jamapediatrics.2020.2592. Online ahead of print.

PMID: 32870260

Simonetti JA, Dorsey Holliman B, Holliday R, Brenner LA, Monteith LL. Correction: Firearm-related experiences and perceptions among United States male veterans: A qualitative interview study. PLoS One. 2020 Apr 2;15(4):e0231493. doi: 10.1371/journal.pone.0231493. eCollection 2020.PMID:

PMID: 32240267

Monteith LL, Holliday R, Dorsey Holliman BA, Brenner LA, Simonetti JA. Understanding female veterans' experiences and perspectives of firearms. J Clin Psychol. 2020 Sep;76(9):1736-1753. doi: 10.1002/jclp.22952. Epub 2020 Mar 30.

PMID: 32227687

Simonetti JA, Piegari R, Maynard C, Brenner LA, Mori A, Post EP, Nelson K, Trivedi R. Characteristics and Injury Mechanisms of Veteran Primary Care Suicide Decedents with and without Diagnosed Mental Illness. J Gen Intern Med. 2020 Mar 26. doi: 10.1007/s11606-020-05787-1. Online ahead of print.

PMID: 32219647

Simonetti JA, Dorsey Holliman B, Holiday R, Brenner LA, Monteith LL. Firearm-related experiences and perceptions among United States male veterans: A qualitative interview study. PLoS One. 2020 Mar 10;15(3):e0230135. doi: 10.1371/journal.pone.0230135. eCollection 2020.

PMID: 32155211

Trivedi RB, Post EP, Piegari R, Simonetti J, Boyko EJ, Asch SM, Mori A, Arnow BA, Fihn SD, Nelson KM, Maynard C. Mortality Among Veterans with Major Mental Illnesses Seen in Primary Care: Results of a National Study of Veteran Deaths. J Gen Intern Med. 2020 Jan;35(1):112-118. doi: 10.1007/s11606-019-05307-w. Epub 2019 Oct 30. PMCID: PMC6957595.

PMID: 31667746

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Media (webinars, podcast, etc.)


Webinar: Firearm Safety and Safety Planning Research: Updates from three SPRINT Planning Award Projects

by Frances Aunon, PhD; Bryann DeBeer, PhD; Marianne Goodman, PhD; Joe Simonetti, MD, MPH
Seminar date: 3/1/2023

Description: This session will begin with a brief discussion of recent updates to SPRINT and its planning award process. Three investigators will then discuss their SPRINT Planning Award projects on suicide prevention research topics including firearm safety and safety planning. They will discuss how they have overcome any challenges and barriers, and status and impacts of their work to date.

Watch: Firearm Safety and Safety Planning Research: Updates from three SPRINT Planning Award Projects

Find the PDF handout and transcript