Study links gun violence to pediatric ED visits for mental health

A study published in JAMA Pediatrics linked exposure to gun violence to a rise in pediatric ED visits for mental health issues, especially for children who witnessed such actions.

Aditi Vasan, MD, MSHP, an instructor of pediatrics at the University of Pennsylvania Perelman School of Medicine and a pediatrician at The Children’s Hospital of Philadelphia, said it is “important” to consider the secondary effects of gun violence on children exposed to shootings.

“As a pediatrician, I've seen patients in the clinic, in the hospital or in the ER come in with symptoms of anxiety or feeling depressed or having difficulty sleeping, or other symptoms of PTSD,” Vasan told Healio. “And then when I asked them when the symptoms started, they tell me that they began after a classmate, or a friend, or someone in their school or neighborhood was shot, and a lot of my colleagues at the Children's Hospital of Philadelphia and in the ER have similar stories. And so that's really what motivated us to do the study, to try to quantify that impact of violence exposure on kids’ mental health.”

After adjusting for age, sex, race and ethnicity, median household income by zip code and insurance, the researchers found that children residing within one-eighth of a mile — or two to three blocks — of a shooting had greater odds of mental health-related ED presentations in the next 14 days (adjusted OR, 1.86 [95% CI, 1.20-2.88]), 30 days (aOR, 1.49 [95% CI, 1.11-2.03]), and 60 days (aOR, 1.35 [95% CI, 1.06-1.72]).

“This effect was greatest for children living closest to the shooting in the 2 weeks immediately after the shooting and for children exposed to multiple shootings,” Vasan said. “Our findings really show that the symptoms of mental health distress in children can appear within days of being exposed to a single shooting.”

Vasan said the findings showed how crucial it could be to recognize symptoms of shooting-related trauma in children.

“For providers, I think it really underscores the importance of providing universal trauma-informed care in the emergency room and in clinics in communities where shootings are common, and really recognizing that many children who come in with mental health symptoms may have been exposed to a shooting, even if they don't report that as the reason why they're coming in,” Vasan said. “It's important to consider that trauma and how it might affect them, and to let them know that there are mental health resources that can help.”

Vasan also said that lasting solutions would require a twofold community-based process.

“We talk about two ways to address these impacts. The first is by reducing and kind of mitigating the mental health symptoms associated with this exposure. And that's what we talked about in terms of trauma informed care and connecting patients and mental health support. The second is by reducing children's exposure to gun violence in the first place, and that's something we can do through evidence-based strategies like storage programs, background check laws and violence prevention programs. That's something we encourage providers to advocate for and support as well.”

Reference:

Vasan A, et al. JAMA Pediatr. 2021;doi:10.1001/jamapediatrics.2021.3512.