Youth who survive a firearm injury are significantly more likely to access mental health services—including services for substance use disorders—within one year of the injury than are children who do not have a firearm injury, according to a report in JAMA Surgery.
The authors noted that health care professionals should be especially aware of the risk for substance use by children and adolescents following a firearm injury. “Adolescents are already vulnerable for developing addictions,” wrote Elizabeth Oddo, M.D., M.P.H., of the Medical University of South Carolina and colleagues. “Substance use in adolescence may worsen preexisting mental health disorders, such as anxiety and depression, and may have negative consequences for attention, learning, and memory.”
The researchers used commercial insurance and Medicaid claims databases to examine use of mental health and substance use treatment among 2,127 children and adolescents (average age 13.5 years) who sustained firearm injuries between January 2016 and the end of December 2017, and an equal number of age-matched youth who had not had a firearm injury. The primary outcome was any mental health care utilization (versus no mental health care utilization) in the 12 months after injury. Secondary outcomes included psychotherapy utilization, substance use–related utilization, and psychotropic medication prescription.
Among those who sustained a firearm injury, 504 youth (23.7%) received at least one mental health service in the 12 months after their injury compared with 351 controls (16.5%); 298 (14.0%) received psychotherapy at least once compared with 237 controls (11.1%); 268 (12.6%) received substance use services compared with 184 controls (8.7%); and 402 (18.9%) had a prescription claim for a psychotropic medication compared with 349 controls (16.4%).
After controlling for several potential confounders, the authors found that youth with a firearm injury had a 1.40 times greater risk of utilizing mental health services in the 12 months after their injury compared with those without a firearm injury. They also had a 1.23 times greater risk of utilizing psychotherapy and a 1.40 times greater risk of utilizing substance use treatment than those without firearm injury. Black youth who were injured by a firearm were 1.64 times more likely to use mental health services compared with White youth with a firearm injury.
“This study included only children and adolescents who had utilized the mental health care system; given what is known about poor access to mental health care in the US, it likely underestimates the burden of psychological distress experienced by this population,” the authors wrote. “Health care practitioners should be aware of this increased risk and ensure adequate mental health follow-up for these patients. Comprehensive solutions aimed at increasing mental health care access for at-risk populations are needed to prevent ongoing negative consequences.”
For related information see the Psychiatric News article “APA Joins New Organization to Address Public Health Crisis Involving Firearms.”
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