Survivors of gunshot wounds often face a long and painful recovery. When gun victims are children or teenagers, family members also face challenges.
In the year after a firearm injury, child and adolescent survivors experienced significant increases in pain, psychiatric and substance use disorders compared to their peers, published study finds Monday in the journal Health Affairs. The mental health of family members has also been affected.
“We can’t treat injuries like this in isolation without thinking about all the factors that arise afterward,” said Dr. Patrick Carter, an emergency physician and co-director of the University’s Firearm Injury Prevention Institute. University of Michigan. Carter was not involved in the study.
Researchers from Harvard University and Massachusetts General Hospital analyzed 15 years of claims data from employer-sponsored health insurance plans. They examined the claims of 2,052 gun injury survivors – from infants to 19-year-olds – in the year before and the year after the injury. They then compared the data to health insurance claims from nearly 10,000 matched controls who were not injured by a gun.
One year after a firearm injury, children and adolescents experienced a 117% increase in pain disorders, a 68% increase in psychiatric disorders including PTSD, anxiety, depression and psychosis , and a 144% increase in substance use disorders compared to controls. .
“Our findings suggest that survivors’ daily struggles to recover, heal, cope and move on are a difficult journey,” said Dr. Zirui Song, one of the paper’s authors and a lead author. of the study. healthcare physician and associate professor of health policy and medicine at Harvard Medical School.
The Centers for Disease Control and Prevention tracks gun deaths in the United States, but there is no official data on nonfatal firearm injuries. In the new study, more than 85,000 people in the United States are estimated to survive gunshot wounds each year, about twice the number of gunshot deaths, although the proportion of children is not known.
Family shares trauma
The researchers also compared the health insurance claims of parents and siblings of survivors to those of family members of children who did not suffer firearm injuries. Mothers of survivors experienced a 30% increase in psychiatric disorders and fathers a 31% increase compared to controls.
“This illustrates the shared trauma experienced by families,” Song said. Her analysis also showed that mothers of survivors may be neglecting their own health care. Their routine office visits decreased by 6%, imaging by 14%, and laboratory tests by 9% compared to controls.
In the study, siblings of children and adolescents injured by firearms did not show an increase in mental health diagnoses and services. The data doesn’t offer an explanation, but Song and his colleagues have a hypothesis.
“Siblings may stay in their rooms on the phone and online, avoiding social interactions, coping in ways that may not be healthy and are less visible to the health care system,” she said. Song said.
In other words, they may not be getting the proper care they need.
The findings provide more evidence of the need for clinicians, communities and policymakers to direct mental health resources toward survivors and their families, experts say.
The researchers limited their study to one year before and one year after a firearm injury because a longer study would have been less rigorous. This would have meant tracking fewer people when employees leave their jobs.
Pediatrician Dr. Katherine Hoops, a faculty member at the Johns Hopkins Center for Gun Violence Solutions, said the fight for survivors and their family members will likely continue beyond the year after the initial injury.
“From my own experience walking alongside families after violent injuries, these things either never go away or it takes a long time for a family, community or individual to deal with them,” said Hoops, who does not did not participate in the study.
“If you talk to someone who has been shot, who has had a child or family member shot, or who has lost a family member to gun violence, they will have no problem talking to you long-term physical, emotional, mental and economic consequences. costs,” said Dr. Elinore Kaufman, a trauma surgeon and medical director of the Penn Trauma Violence Recovery Program at Penn Presbyterian Medical Center in Philadelphia.
For Keely Roberts, who along with her son Cooper was among the victims of the July 4, 2022 shooting in Highland Park, Illinois, recovery sometimes feels like “two steps forward” followed by “moments where there are three steps backward “.
Cooper, then 8 years old, was paralyzed and now uses a wheelchair. Roberts said Cooper tried to be positive, but like the children in the study, he struggled to cope with the aftermath of the shooting.
“Everything in our life has been destroyed, and her little body is so hurt,” Roberts said in an interview.
Returning to school is a comfort for Cooper but also a source of anxiety, heartache and grief, Roberts said. “He was so happy to see his friends again and it brought him immense comfort, but it was also a reminder of what had been stolen from him, what had been so painfully taken away from him.”
Roberts said the school and community have been tremendously supportive, as have her son’s medical providers who told the family from day one that there would be mental health issues ahead. The counseling has helped everyone in the family, she said, although progress has been uneven.
And like the mothers participating in the new research, Roberts neglected her own routine health care. She took time off from her job to give Cooper the care he needs, but “there are only so many hours in the day and something has to give,” she said .
Health Care Costs for Firearm Injury
Not surprisingly, the study showed that health care costs increased when there was a firearm injury. Health care costs increased by $2,907 per month, on average, for each surviving child and adolescent, compared to controls. It is estimated that 5% of additional expenses came from patients’ pockets. Insurance increased by 95%.
The study had several limitations, according to the researchers. For example, claims data comes only from commercial health insurance. But a large proportion of people who suffer gun injuries are on Medicaid — government health insurance for adults and children with limited income and resources — or are uninsured, Kaufman said.
Gun violence is highly concentrated among low-resource populations and people of color due to “structural racism and disenfranchisement in the United States,” Kaufman said. “This study therefore does not represent the most vulnerable population,” she added.
Song and colleagues are currently undertaking a similar study among Medicaid beneficiaries.
Despite its limitations, Carter, of the University of Michigan, said the new research is an important contribution that will inform the debate about gun violence, particularly the need to invest in prevention.
“If we can prevent firearm injuries, then we will avoid all of these enormous physical, mental and economic costs that come with them,” Carter said.