Child Survivors of Gun Violence More Likely to Experience Substance Abuse and Mental Health Issues
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For over 60 years, car accidents were the leading cause of death in children and teens in the United States. After the start of the pandemic in 2020, though, their number one cause of death became gun violence — and it’s remained in the top spot ever since.
In 2022, more than 4,500 youths in the United States died of firearm injuries. Thousands more survive being shot each year, experiencing lasting physical harm as well as psychological repercussions — for themselves, their parents, and their siblings — that can linger for years or even decades, according to the findings of a new study published in the November issue of Health Affairs.
The tragedy of youth gun violence in its immediate aftermath overshadows the massive health crises that occur in the long wake of injuries and deaths, says Zirui Song, MD, PhD, an author of the study and an associate professor of healthcare policy and medicine in the Blavatnik Institute at Harvard Medical School in Boston.
“Survivors of firearm injury are often forgotten, as are family members who share in the trauma. Family members are survivors too, confronted with their own mental health and healthcare consequences despite not being shot themselves.” he says.
And while it’s impossible to put a price on the unimaginable suffering a family experiences when a child is shot, the resulting medical care is expensive — costing around $35,000 in health spending per survivor in the first year alone, Dr. Song says.
EXPERT Q&A: How to Talk to Your Children After a School Shooting
Firearm injuries are directly affecting the rise in anxiety among children attending school, says Douglas Tynan, PhD, a psychologist at Bryn Mawr Psychology Associates in Pennsylvania and the president of the Delaware Psychological Association. Dr. Tynan, who was not involved in this study, has authored papers on the role of health and mental health providers in gun violence prevention.
“Those advocates who oppose any restrictions on firearms need to accept responsibility for the world they are creating. They must pay for the financial costs and attend to the needs of those who have been injured or killed,” he says.
Gun Violence Harms Black Children 20 Times More Than Their White Peers
In the past decade, the gun death rate among children and teens has increased by 87 percent. In fact, 2021 and 2022 saw the highest rates in 25 years, according to an analysis by Johns Hopkins Bloomberg School of Public Health using provisional data from the Centers for Disease Control and Prevention (CDC).
Gun violence has a dramatically disproportionate impact on Black children and teens, who have a gun homicide rate 20 times higher than white children, per the data.
Young Survivors of Gun Injuries Are More Likely to Experience Substance Use Disorders and Mental Health Issues
Most previous research on the effects of firearm injuries have either left kids out or lumped them together with adults, according to the investigators behind the Health Affairs study. Their research — the most rigorous to date that looks at children — shows that the impact on family members is even greater when a young person suffers a firearm injury than when an adult family member is injured.
Researchers analyzed commercial health insurance claims to study three groups of people:
- 2,502 child and adolescent (ages 0 to 19 years old) gunshot survivors were compared with a control group of 9,983 similar young people who did not experience gun injuries
- 6,209 family members of survivors (moms, dads, siblings) were compared with 29,877 peers who did not have such an experience
- 265 family members of young people who died from a firearm injury were compared with 1,263 people who did not experience the loss of a child or sibling to gunshots
Key findings from the analysis included the following:
- Investigators found that young survivors had a 68 percent increase in psychiatric disorders, a 117 percent increase in pain disorders, and a 144 percent increase in substance use disorders compared with the control group.
- Survivors averaged $34,884 more spending in healthcare in the first year after the shooting than the control group — 17 times higher than their pre-injury spending.
- Parents of survivors experienced an estimated 30 percent increase in psychiatric disorders, with 75 percent more mental health visits by mothers, and 5 to 14 percent reductions in mothers’ and siblings’ routine medical care.
- Those who lost a child or a sibling to firearm injuries experienced more than twice as many psychiatric disorders after their loss than before it. The increase in fathers was particularly sharp, with more than five times as many psychiatric disorders in the months following the fatal shooting of a child than in the months before.
- Mothers of children who were killed had a 15-fold increase in mental health visits, and fathers, who rarely had mental health care before losing their child, exhibited an 87-fold increase in mental health visits.
Public Awareness of Young Gun Violence Survivors Is Key
It’s important to build awareness around young gun violence survivors and their families, says Song. “The public largely hears about deaths from firearms, yet deaths are the tip of the iceberg. Survivors are the bottom of the iceberg, often forgotten on their lonely road to recovery,” he says.
Moreover, this study shows that you don’t need to be shot yourself to be a survivor, says Song: “The shared trauma of a child’s or sibling’s firearm injury alone is detrimental to health. It’s important for clinicians to be aware that these families are at an increased risk for these conditions so that they can receive the support and care they need.”
By focusing on child survivors of gun violence and their family members along with family members of children who died — and comparing them all with a control group of people with the same insurance, living in the same neighborhoods — this well-designed study was able to show the enormous healthcare costs in the first year and ongoing health and mental health expenses in both groups, says Tynan.
“This study looked at healthcare, but there are also ongoing costs in public education and other costs to society, such as loss of employment. People should be aware of these costs, and the public should not assume [responsibility for] these costs,” says Tynan. Taxes on guns and ammunition would be one obvious solution, he adds.
These findings can help clinicians more promptly identify people in need of help by improving screening for mental health problems not only among survivors of firearm injuries, but also among their siblings, parents, and even other family members, according to the authors. This trauma-informed approach is key, and it is starting to be taught more to medical trainees, the researchers said.
Findings Emphasize the Importance of Gun Safety
The researchers emphasized that it is also important for everyone to practice gun safety, since children and teens are exposed to firearms more and more often. Studies have shown that living in a home with firearms increases the risk of firearm injuries, wrote the authors.
An estimated 30 million children in the United States live in households with firearms, and nearly 4.6 million children in the United States live in homes where at least one firearm is kept loaded and unlocked, according to a paper published in the February 2022 JAMA Pediatrics.
“From a public health perspective, we spend a lot of time on seat belts and car seats. Let’s have similar public health information on safe storage,” says Tynan.
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