The incidence of the abuse of firearms varies from one country to another, but it generally constitutes a primary cause of death in the more industrialized countries (WHO 2000).
The assessment and certification of fitness to possess firearms is a complex medical procedure, due partly to the scarcity of empirical studies from which to glean suitable assessment criteria (Clerici 2006), and partly to a presumably scarce specific training of the clinicians involved.
The problem is important in Italy, given the number of people (4,800,000 according to the latest estimate) who possess firearms or use them for recreational or sporting purposes (with an estimated total number of 10-12,000,000 firearms in circulation).

Their fitness to own such weapons is assessed by means of a clinical history certificate issued by their general practitioners and a subsequent certificate of psychophysical suitability issued by a public health officer at the Local Public Health Unit, or a physician in the Armed Forces, or a physician in the state police. For the time being, these clinicians undertake no specific training on this issue during their university or specialty medical studies. Physicians working as general practitioners, psychiatrists, psychologists or psychotherapists have to deal with clinical situations involving patients at risk of suicidal or homicidal behavior without being able to access any information on whether or not they possess any firearms.

The topic of weapons always triggers contrasting reactions and this has probably not facilitated our scientific understanding of the phenomenon and any related preventive measures.

The majority of studies on the phenomenon of weapons abuse have been conducted in the United States.
The situation in the USA is of special interest because it has certain particular features. In June 2008 the United States Supreme Court confirmed and reinforced, the individual’s right to possess firearms. It reiterated the validity of the second amendment of the American Constitution and declared that the law of the District of Colombia (which includes the US capital, Washington) forbidding its residents from owning pistols and guns was unconstitutional.
This fact created quite a fuss in the media and the question was also discussed by the main international medical journals.
Clearly, the particular legislative situation, the social, economic and cultural features of the population of the USA, and the widespread possession of firearms mean that American scientific experiences on the matter cannot be extended directly to the European context, and to Italy.

In Italy, research has also been hindered by the lack of basic information available, such as the number of weapons legally possessed over the years by its citizens. But the problem of the psychiatric assessment relating to the matter of firearms permits is likely to remain important in years to come.
The political decision concerning whether or not to restrict the legal possession of firearms suffers from doubts as to its efficacy. While some research has identified a reduction in the number of homicides and suicides since the introduction of more restrictive laws on firearms possession, such an effect has not been confirmed in all settings.
In addition, the growing demand for security that drives some citizens to purchase firearms, and the large number of people who legitimately practise sporting and recreational activities that involve the use of firearms (such as hunting and shooting for sport) make it hardly likely that any changes will be made make the legislation will restrictive in Italy.
Improving prevention methods without any pointless extra burden on the national health system and on the country’s citizens consequently becomes a priority concern.
Our work group has been studying the phenomenon for some years, and has developed the WAR (weapons assessment risk) model to assess the risk of firearms abuse as part of a cooperative scheme currently underway, involving researchers in the psychiatric, psychological and criminological disciplines.
There is an investigation currently underway on the training of clinicians vis-à-vis the problem of the risk of firearms abuse and on their perception of their capacity to clinically manage patients who legally own firearms.
The scheme involves a data collection phase, organized into several successive stages, based on the computer-based distribution of a questionnaire to physicians and psychologists.
The data collected may provide a basis for the often-announced legislative reforms on the matter of firearms and for guidelines on training programs for physicians and psychologists.