“As a pediatric emergency medicine physician, it’s devastating each time I treat a child who has sustained a firearm injury,” Jennifer A. Hoffmann, MD, MS, says. “I worry not only about how the injury affects the child’s physical health, but also their mental health (MH). We wanted to understand which children received timely MH care after a firearm injury, because we know that early detection and treatment of MH symptoms is often more effective and requires less intensive treatment.”

For a study published in Pediatrics, Dr. Hoffmann and colleagues assessed variations in the timing of a child’s first outpatient MH visit following a nonfatal firearm injury. They examined children aged 517 from 11 US states who were insured through Medicaid and had a firearm injury between 2010 and 2018.

Logistic regression estimated the likelihood of MH service use in the 6 months following the injury, with adjustments for sociodemographic and clinical factors. The study team also assessed variations in the time to a first outpatient MH visit based on sociodemographic and clinical factors.

Impact of Previous Access to Mental Healthcare

The analysis included 2,613 children (83.6% boys; 68.7% Black) with a firearm injury, more than half of whom (64.5%) were aged 15-17. About half of the firearm injuries occurred on an extremity (52.6%).

Following a firearm injury, 36.7% of children received MH services within 6 months; 39.5% of children in this group had no prior use of MH services. Dr. Hoffmann and colleagues reported that the adjusted odds of receiving MH services after the injury was greater among children with prior receipt of MH services (adjusted OR [aOR], 10.41; 95% CI, 8.45-12.82) and more likely for White children compared with Black children (aOR, 1.29; 95% CI, 1.02-1.63). Further, the first outpatient MH visit following the injury took place sooner for children with prior receipt of MH services (adjusted HR [aHR], 6.32; 95% CI, 5.45-7.32).

For children with no prior use of MH services, the initial outpatient visit for MH took place more quickly if the MH diagnosis was made during the healthcare visit for the firearm injury (aHR, 2.72; 95% CI, 2.04-3.65).

“The finding that children who were already receiving MH care before their firearm injury were much more likely to receive timely MH services after the injury suggests that children without an established source of MH care face additional barriers to accessing MH services after a firearm injury,” Dr. Hoffmann says (Figure). “Black children were also less likely to receive any MH services than White children, demonstrating inequities in access to MH care.”

Call to Action for Pediatricians

Overall, the results indicate “that children injured by firearms do not have adequate access to MH services,” Dr. Hoffmann continues. As a result, pediatricians caring for this population of children “should screen for MH sequelae and work to ensure timely access to services,” she says.

“Common new MH conditions after firearm injury included trauma and stress-related disorders, such as PTSD and substance use,” she adds. “Pediatricians can also play a role in preventing firearm injuries by counseling parents to store firearms in and around the home safely.”

On a broader scale, Dr. Hoffmann notes funding for research on firearm injuries “is far below where it should be, based on the associated morbidity and mortality burden,” despite the need for additional work in this area.

“Further research is needed to fully understand the long-term MH consequences of firearm injuries and how to facilitate equitable, timely access to MH care for injured children,” she says.