Healthcare utilization and mental health outcomes among nonfatal shooting assault victims

Magee, Lauren A.; Fortenberry, J.Dennis; Aalsma, Matthew C.; Gharbi, Sami; Wiehe, Sarah E.

doi:10.1016/j.pmedr.2022.101824

Cited by 12 publications

(14 citation statements)

References 49 publications

(55 reference statements)

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“…Additionally, we demonstrated high rates of acute mortality, critical care, blood transfusions, and surgical procedures after police shootings comparable with reports from diverse contexts . Our finding of a significant increase in psychiatric care after a shooting corroborates past research on individuals experiencing nonfatal shooting assault . In line with qualitative research, we found substantial delayed consequences, including ongoing health care costs and long-term disability .…”

Section: Discussionsupporting

confidence: 88%

“…71,72 Our finding of a significant increase in psychiatric care after a shooting corroborates past research on individuals experiencing nonfatal shooting assault. 73 In line with qualitative research, we found substantial delayed consequences, including ongoing health care costs and longterm disability. 74,75 Consistent with social science descriptions, we found extensive psychiatric burden for patients who survive a police shooting.…”

Section: Past Researchsupporting

confidence: 77%

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Costs for Long-Term Health Care After a Police Shooting in Ontario, Canada

Raza,

Thiruchelvam,

Redelmeier

2023

JAMA Netw Open

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ImportancePolice shootings can cause serious acute injury, and knowledge of subsequent health outcomes may inform interventions to improve care.ObjectiveTo analyze long-term health care costs among survivors of police shootings compared with those surviving nonfirearm police enforcement injuries using a retrospective design.Design, Setting, and ParticipantsThis population-based cohort analysis identified adults (age ≥16 years) who were injured by police and required emergency medical care between April 1, 2002, and March 31, 2022, in Ontario, Canada.ExposurePolice shootings compared with other mechanisms of injury involving police.Main Outcomes and MeasuresLong-term health care costs determined using a validated costing algorithm. Secondary outcomes included short-term mortality, acute care treatments, and rates of subsequent disability.ResultsOver the study, 13 545 adults were injured from police enforcement (mean [SD] age, 35 [12] years; 11 637 males [86%]). A total of 13 520 individuals survived acute injury, and 8755 had long-term financial data available (88 surviving firearm injury, 8667 surviving nonfirearm injury). Patients surviving firearm injury had 3 times greater health care costs per year (CAD$16 223 vs CAD$5412; mean increase, CAD$9967; 95% CI, 6697-13 237; US $11 982 vs US $3997; mean increase, US $7361; 95% CI, 4946-9776; P &lt; .001). Greater costs after a firearm injury were not explained by baseline costs and primarily reflected increased psychiatric care. Other characteristics associated with increased long-term health care costs included prior mental illness and a substance use diagnosis.Conclusions and RelevanceIn this longitudinal cohort study of long-term health care costs, patients surviving a police shooting had substantial health care costs compared with those injured from other forms of police enforcement. Costs primarily reflected psychiatric care and suggest the need to prioritize early recognition and prevention.

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Section: Discussionsupporting

confidence: 88%

Section: Past Researchsupporting

confidence: 77%

Costs for Long-Term Health Care After a Police Shooting in Ontario, Canada

Raza,

Thiruchelvam,

Redelmeier

2023

JAMA Netw Open

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“…This speaks to a growing burden of mental illness in this already vulnerable population. For example, in a study of nonfatal firearm injuries, those with preexisting MI were significantly more likely to receive another diagnosis within 24 months following their injury 31 . While the risk of developing a new diagnosis was significantly higher among those with MI, a nearly 10% development of diagnosed MI following violent trauma in patients not previously diagnosed with any kind of MI is not unsubstantial and places them at risk of future sequelae.…”

Section: Discussionmentioning

confidence: 99%

“…For example, in a study of nonfatal firearm injuries, those with preexisting MI were significantly more likely to receive another diagnosis within 24 months following their injury. 31 While the risk of developing a new diagnosis was significantly higher among those with MI, a nearly 10% development of diagnosed MI following violent trauma in patients not previously diagnosed with any kind of MI is not unsubstantial and places them at risk of future sequelae. In general, a high proportion of victims of violence screen positive for symptoms of post-traumatic stress disorder following trauma 8,32,33 and exposure to prior trauma, intentional injury and pretrauma psychopathology only increase these risks.…”

Section: Development Of New Mental Illnessmentioning

confidence: 99%

History repeats itself: Impact of mental illness on violent reinjury and hospital reencounters among female victims of interpersonal violence

Neufeld

Plaitano

Janeway

et al. 2023

J Trauma Acute Care Surg

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“…Firearm injury is associated with increased severity of adverse health outcomes and mental health needs, further compounding existing health and racial inequities among survivors and communities . Adult and pediatric survivors experience high rates of posttraumatic stress disorder, anxiety, and depression . Several survivors have expressed the need for accessible mental health services, both for themselves and their families .…”

Section: Introductionmentioning

confidence: 99%

Engagement With Mental Health Services Among Survivors of Firearm Injury

Magee,

Ortiz,

Adams

et al. 2023

JAMA Netw Open

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ImportanceDespite the prevalence of posttraumatic stress symptoms after firearm injury, little is known about how firearm injury survivors connect with mental health services.ObjectiveTo determine facilitators and barriers to mental health care engagement among firearm injury survivors.Design, Setting, and ParticipantsA qualitative study of 1-on-1, semistructured interviews conducted within a community setting in Indianapolis, Indiana, between June 2021 and January 2022. Participants were recruited via community partners and snowball sampling. Participants who survived an intentional firearm injury, were shot within Indianapolis, were aged 13 years or older, and were English speaking were eligible. Participants were asked to discuss their lives after firearm injury, the emotional consequences of their injury, and their utilization patterns of mental health services. Data were analyzed from August 2022 to June 2023.Main Outcomes and MeasuresSurvivors’ lived experience after firearm injury, sources of emotional support, mental health utilization, and their desired engagement with mental health care after firearm injury.ResultsA total of 18 participants (17 were Black [94%], 16 were male [89%], and 14 were aged between 13 and 24 years [77%]) who survived a firearm injury were interviewed. Survivors described family members, friends, and informal networks as their main source of emotional support. Barriers to mental health care utilization were perceived as a lack of benefit to services, distrust in practitioners, and fear of stigma. Credible messengers served as facilitators to mental health care. Survivors also described the emotional impact their shooting had on their families, particularly mothers, partners, and children.Conclusions and RelevanceIn this study of survivors of firearm injury, findings illustrated the consequences of stigma and fear when seeking mental health care, inadequate trusted resources, and the need for awareness of and access to mental health resources for family members and communities most impacted by firearm injury. Future studies should evaluate whether community capacity building, digital health delivery, and trauma-informed public health campaigns could overcome these barriers to mitigate the emotional trauma of firearm injuries to reduce health disparities and prevent future firearm violence.

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Healthcare utilization and mental health outcomes among nonfatal shooting assault victims

Cited by 12 publications

References 49 publications

Costs for Long-Term Health Care After a Police Shooting in Ontario, Canada

Costs for Long-Term Health Care After a Police Shooting in Ontario, Canada

History repeats itself: Impact of mental illness on violent reinjury and hospital reencounters among female victims of interpersonal violence

Engagement With Mental Health Services Among Survivors of Firearm Injury

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