In 2020, more than 11,000 US children were survivors of firearm injuries. It may seem obvious that many of these children will be emotionally traumatized by the injury event and will benefit from mental health services. Who gets mental health services and how quickly after a firearm injury?
This week, Pediatrics is early releasing an article and an accompanying video abstract entitled, “Timing of Mental Health Service Use after a Pediatric Firearm Injury” (10.1542/peds.2023-061241) that looks at this question. In this article by Dr. Jennifer Hoffmann from Lurie Children’s Hospital and colleagues from 10 other institutions, authors conducted a secondary data analysis of 2010-2018 national Medicaid claims data.
The authors included children aged 5-17 years who were seen in the emergency department or admitted for a nonfatal firearm injury. They determined if patients had received any mental health services (outpatient, emergency department, or inpatient) in the 6 months before and after the injury.
Of 2,613 children who had a nonfatal firearm injury, only one-third received mental health services within 6 months of the injury.
Who was more likely to get mental health services?
- Those who had received mental health services before the firearm injury (10 times more likely than those who had not received services before the injury)
- Those who were classified as non-Hispanic white (29% more likely than those classified as non-Hispanic Black)
- For children without a history of prior mental health use, those who were received a mental health diagnosis during the encounter for the injury (2.7 times more likely)
The authors note that 30% of children had received mental health services before the firearm injury. Given that many of these children had a diagnosis of ADHD or disruptive behavior disorders, it is possible that the impulsivity associated with these conditions may have increased the risk of firearm injury.
The two most common mental health diagnoses were substance abuse and trauma-related disorders.
It is remarkable – and quite sobering – that nearly two-thirds of children who survived a firearm injury did not receive any mental health services.
I think the take-home message is that we need to do mental health screening of all children who survive a firearm injury. I suspect that more than one-third of them would benefit from mental health services.
