Mental Healthcare Following Firearm and Motor Vehicle Related Injuries: Differences Impacting Our Treatment Strategies

• Type of Material: Article
• Authors: Peter F. Ehrlich, University of Michigan; Christian D. Pulcini, University of Vermont; Heidi G. Souza, Children's Hospital Association; Matt Hall, Children's Hospital Association; Annie Andrews, Medical College of South Carolina; Bonnie T. Zima, University of California at Los Angeles; Joel A. Fein, University of Pennsylvania; Sofia Chaudhary, Emory University; Jennifer A. Hoffmann, Northwestern University; Eric W. Fleegler, Harvard Medical School; Kristyn N. Jeffries, Children's Mercy Hospitals; Monika K. Goyal, George Washington University; Stephen Hargarten, Medical College of Wisconsin; Elizabeth R. Alpern, Northwestern University
• Language: English
• Date: 2022-06-28
• Publisher: Wolters Kluwer Health Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): https://doi.org/10.1097%2FSLA.0000000000005557
• Title of Journal or Parent Work: Annals of Surgery
• Volume: 276
• Issue: 3
• Start Page: 463
• End Page: 471
• Grant/Funding Information: This work has been partially supported by The FACTS (Firearm safety Among Children & Teens) / Building Research Capacity for Firearm Safety Among Children Consortium grant NICHD, 1R24HD087149.
• Keywords: Motor Vehicle Crash; Mental Health; Pediatric; Firearm
• Research Categories: Health Sciences, Public Health; Health Sciences, Mental Health

Abstract

Objective: To compare new mental health diagnoses (NMHD) in children after a firearm injury versus following a motor vehicle collision (MVC). Summary Background Data: A knowledge gap exists regarding childhood mental health diagnoses following firearm injuries, notably in comparison to other forms of traumatic injury. Methods: We utilized Medicaid MarketScan claims (2010–2016) to conduct a matched case-control study of children ages 3–17 years. Children with firearm injuries were matched with up to three children with MVC injuries. Severity was determined by injury severity score (ISS) and emergency department (ED) disposition. We used multivariable logistic regression to measure the association of acquiring a NMHD diagnosis in the year post-injury after firearm and MVC mechanisms. Results: We matched 1450 children with firearm injuries to 3691 children with MVC injuries. Compared to MVC injuries, children with firearm injuries were more likely to be black, have higher ISS, and receive hospital admission from the ED (p<0.001). The adjusted odds ratio (aOR) of NMHD diagnosis was 1.55 [95% CI 1.33,1.80] greater after firearm injuries compared to MVC injuries. The odds of a NMHD were higher among children admitted to the hospital compared to those discharged. The increased odds of NMHD after firearm injuries was driven by increases in substance-related and addictive disorders (aOR 2.08 [95% CI 1.63, 2.64]) and trauma and stressor-related disorders (aOR 2.07 [95% CI 1.55, 2.76]). Conclusions: Children were found to have 50% increased odds of having a NMHD in the year following a firearm injury as compared to MVC. Programmatic interventions are needed to address children’s mental health following firearm injuries.