Mental Health Care Utilization Among Children and Adolescents With a Firearm Injury

Abstract

ImportanceFirearm injuries are a leading cause of morbidity and mortality among US children and adolescents. Despite evidence demonstrating mental health sequelae for children and adolescents who have experienced a firearm injury, little is known about mental health care utilization after a firearm injury.ObjectiveTo evaluate mental health care utilization in the 12 months after a firearm injury among Medicaid-insured and commercially insured children and adolescents compared with propensity score–matched controls.Design, Setting, and ParticipantsThis propensity score–matched retrospective cohort analysis assessed 2127 children and adolescents, aged 0 to 17 years, with a firearm injury that occurred between January 1, 2016, and December 31, 2017, compared with 2127 matched controls using MarketScan Medicaid and commercial claims data. Claims data were analyzed 12 months before and after injury, with the total study period spanning from January 1, 2015, to December 31, 2018.ExposureNonfatal firearm injury.Main Outcomes and MeasuresThe primary outcome of interest was a dichotomous variable representing any mental health care utilization in the 12 months after injury. Secondary outcomes included psychotherapy utilization, substance use–related utilization, and a psychotropic medication prescription. Logistic regression modeling was used to estimate relative risks with adjusted analyses of dichotomous outcomes.ResultsThe overall cohort consisted of 4254 children and adolescents, of whom 2127 (mean [SD] age, 13.5 [4.1] years; 1722 [81.0%] male) had an initial encounter for a firearm injury and an equal number of matched controls (mean [SD] age, 13.5 [4.1] years; 1720 [80.9%] male). Children and adolescents with a firearm injury had a 1.40 times greater risk (95% CI, 1.25-1.56; P < .001) of utilizing mental health services in the 12 months after their injury compared with children and adolescents without a firearm injury, after controlling for potential confounders. Children and adolescents with a firearm injury had a 1.23 times greater risk (95% CI, 1.06-1.43; P = .007) of utilizing psychotherapy and a 1.40 times greater risk (95% CI, 1.19-1.64; P < .001) of substance use–related utilization. Among those who experienced a firearm injury, Black children and adolescents were 1.64 times more likely (95% CI, 1.23-2.19; P < .001) to utilize mental health care compared with White children and adolescents.Conclusions and RelevanceThis propensity score–matched cohort study found that children and adolescents with a firearm injury had a greater risk of utilizing mental health services in the 12 months after their injury compared with those without an injury, and significant racial disparities were associated with use of mental health services. The findings suggest that health care practitioners should be aware of this increased risk and ensure adequate mental health follow-up for these patients.

Long-term physical and mental health outcomes of pediatric firearm-injured victims: A prospective cohort study

“…Previous retrospective studies have identified increased anxiety, depression, and posttraumatic stress disorders in firearminjured youth 1 year postinjury. [5][6][7] Our study adds to the existing body of literature, demonstrating that deleterious effects are pervasive beyond 1 year. Our findings point to a need for multicenter prospective research with set time points and diagnostic interviews.…”

“…4 Pediatric studies using administrative data have shown associations between nonfatal firearm injuries and increased mental health diagnoses, substance-related disorders, and stress-related disorders in the year following injury. 5,6 In addition, firearm-injured youth have greater health care encounters, chronic conditions, and expenditures than matched controls. 7 These studies do not capture youth who did not seek or could not access healthcare, and their retrospective design prevents a more nuanced understanding of patient needs and outcomes.…”

Pediatric Firearm Injury

“…In a recent propensity score-matched analysis comparing youth who had or had not experienced nonfatal firearm injuries, children suffering from firearm injury had a 1.23 times greater risk of utilizing psychotherapy and 1.40 times greater risk of utilizing substance abuse treatment than those without firearm injury. Finally, Black children and adolescents were 1.64 times more likely to utilize mental health care compared with their White counterparts who also experienced firearm injury 14. These illuminating statistics emphasize the importance of the continued development of programs and access to provide mental health care services for our youth in this critical time after their injury.…”

“…Finally, Black children and adolescents were 1.64 times more likely to utilize mental health care compared with their White counterparts who also experienced firearm injury. 14 These illuminating statistics emphasize the importance of the continued development of programs and access to provide mental health care services for our youth in this critical time after their injury. Early intervention programs and timely follow-up after their index hospitalization may help mitigate the ongoing effects of these injuries on the mental health of youth, trauma recidivism, and potential future criminal justice involvement.…”

The Importance of Mental Health Services for Children and Adolescents After Firearm-Related Injury

“…The far-reaching, adverse outcomes of firearm-related injuries have been described in the literature, including poor mental health sequelae . In this issue of JAMA Surgery , Oddo and colleagues identified that insured children and adolescents, aged 0 to 17 years, in the US who experienced a nonfatal firearm-related injury were 1.40 times more likely to utilize mental health services in the 12 months following their injury compared with uninjured youths. Among those injured, Black youths were 1.64 times more likely to utilize these services than were White youths.…”