Association of Neighborhood Gun Violence With Mental Health–Related Pediatric Emergency Department Utilization

Abstract

IMPORTANCE Many children and adolescents in the United States are exposed to neighborhood gun violence. Associations between violence exposure and children's short-term mental health are not well understood.OBJECTIVE To examine the association between neighborhood gun violence and subsequent mental health-related pediatric emergency department (ED) utilization. DESIGN, SETTING, AND PARTICIPANTSThis location-based cross-sectional study included 128 683 ED encounters for children aged 0 to 19 years living in 12 zip codes in Philadelphia, Pennsylvania, who presented to an urban academic pediatric ED from January 1, 2014, to December 31, 2018. Children were included if they (1) had 1 or more ED visits in the 60 days before or after a neighborhood shooting and (2) lived within a quarter-mile radius of the location where this shooting occurred. Analysis began August 2020 and ended May 2021.EXPOSURE Neighborhood violence exposure, as measured by whether a patient resided near 1 or more episodes of police-reported gun violence. MAIN OUTCOMES AND MEASURES ED encounters for a mental health-related chief complaint or primary diagnosis.RESULTS A total of 2629 people were shot in the study area between 2014 and 2018, and 54 341 children living nearby had 1 or more ED visits within 60 days of a shooting. The majority of these children were Black (45 946 [84.5%]) and were insured by Medicaid (42 480 [78.1%]). After adjusting for age, sex, race and ethnicity, median household income by zip code, and insurance, children residing within one-eighth of a mile (2-3 blocks) of a shooting had greater odds of mental health-related ED presentations in the subsequent 14 days (adjusted odds ratio, 1.86 [95% CI, 1.20-2.88]), 30 days (adjusted odds ratio, 1.49 [95% CI, 1.11-2.03]), and 60 days (adjusted odds ratio, 1.35 [95% CI, 1.06-1.72]).CONCLUSIONS AND RELEVANCE Exposure to neighborhood gun violence is associated with an increase in children's acute mental health symptoms. City health departments and pediatric health care systems should work together to provide community-based support for children and families exposed to violence and trauma-informed care for the subset of these children who subsequently present to the ED. Policies aimed at reducing children's exposure to neighborhood gun violence and mitigating the mental symptoms associated with gun violence exposure must be a public health priority.

Changing epidemiology of firearm injury: a cohort study of non-fatal firearm victimisation before and during the COVID-19 pandemic, Indianapolis, Indiana

“…Finally, our findings indicate higher rates of non-fatal firearm injuries continue to occur in structurally disadvantaged communities, further contributing to health disparities in communities that have experienced structural disadvantage and racial inequalities for decades 26 29. A growing body of research demonstrates levels of community firearm violence not only impacts the victim but contributes to higher levels of resident disability, adverse health outcomes and mental health needs among adults and children who are indirectly impacted by the continued trauma of firearm violence 15–17. Disadvantaged communities often lack available healthcare or posthospital care is difficult for victims to obtain,30 leaving victims and communities to cope with the trauma of their injuries alone, consequently compounding inequalities.…”

“…Survivors of non-fatal firearm injuries are more likely to suffer adverse health outcomes such as physical disabilities, chronic pain, post-traumatic stress disorder, depression and substance use 12 13. Beyond non-fatal injury survivors, a growing body of research suggests exposure (both direct and indirect) to fatal and non-fatal firearm injuries increases adverse health outcomes, such as worse mental health outcomes for residents 14 15. Community rates of non-fatal firearm injuries are associated with higher levels of obesity, smoking, lack of sleep, physical inactivity and higher levels of disability at the community level, compared with fatal firearm injuries 16 17.…”

Healthcare utilization and mental health outcomes among nonfatal shooting assault victims

“…Primary care and emergency department encounters may be an opportunity to screen and connect victims with mental health services ( Rosen et al, 2019 , Abaya et al, 2019 , Ngo et al, 2019 ), however more research is needed to evaluate such programs ( Roszko et al, 2016 ). There is also a growing body of research that demonstrates community exposure to firearm violence increases adverse mental health outcomes due to the trauma exposure ( Vasan et al, 2021 , Leibbrand et al, 2020 ). Therefore, it is also important to develop and maintain community partnerships to broaden the scope of mental health services for victims of firearm violence and work to connect victims with community groups who are providing mental health care within a setting that may be more comfortable for victims versus a hospital setting ( Radez et al, 2021 ).…”

Racial Disparities in Child Exposure to Firearm Violence Before and During COVID-19

“…This outcome is referred to here as “neighborhood exposure to firearm violence.” Although some exposure to violence occurs outside a child's home neighborhood, a majority occurs within the home neighborhood, 17 and home neighborhood exposures are associated with childhood outcomes. 3 , 5 This “neighborhood effects” approach treats monitoring of neighborhood firearm violence as akin to monitoring the presence of other neighborhood-level determinants of health, such as air and water quality, and healthy food access, for example. From this social ecological standpoint, racial health disparities emerge from the differences in social context that U.S. society allocates inequitably according to racial status.…”

“…Each type of firearm violence exposure can contribute to adverse child outcomes. Children exposed to firearm violence, whether directly or indirectly, may experience adverse short-term and long-term psychological effects, 3 including post-traumatic stress disorder. 2 These effects of trauma carry over into student learning outcomes, physical health, and emotional well-being.…”