Mental Health Utilization and Expenditures for Children Pre–Post Firearm Injury

Pulcini, Christian D.; Goyal, Monika K.; Hall, Matt; Souza, Heidi Gruhler De; Chaudhary, Sofia; Fein, Joel A.; Fleegler, Eric W.

doi:10.1016/j.amepre.2021.01.024

Cited by 14 publications

(6 citation statements)

References 5 publications

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“…Although this study focused on firearm-related deaths, most people who experi-ence firearm violence survive but with substantial detrimental physical, mental health, and community-related outcomes. 57,58 Survivors of firearm violence compared with the general population have higher health care and intensive care unit utilization rates, higher rates of alcohol and substance use disorder, and greater risk of posttraumatic stress disorder. [57][58][59][60][61]…”

Section: Discussionmentioning

confidence: 99%

“…57,58 Survivors of firearm violence compared with the general population have higher health care and intensive care unit utilization rates, higher rates of alcohol and substance use disorder, and greater risk of posttraumatic stress disorder. [57][58][59][60][61]…”

Section: Discussionmentioning

confidence: 99%

“…Additional research is warranted to better elucidate how the risk of firearm-related death may change along with changes in the poverty concentration of a community over time, as well as how the risk conferred by the length of time spent in a community with a high poverty level may modulate one’s risk of firearm-related death. Although this study focused on firearm-related deaths, most people who experience firearm violence survive but with substantial detrimental physical, mental health, and community-related outcomes . Survivors of firearm violence compared with the general population have higher health care and intensive care unit utilization rates, higher rates of alcohol and substance use disorder, and greater risk of posttraumatic stress disorder …”

Section: Discussionmentioning

confidence: 99%

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Association of County-Level Poverty and Inequities With Firearm-Related Mortality in US Youth

et al. 2022

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IMPORTANCE Youth firearm-related deaths are a public health crisis in the US. The association between county-level poverty and the risk of firearm-related deaths among youth is unknown, however.OBJECTIVE To examine the association between county-level poverty concentration and firearm-related mortality rates in US youth. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study analyzed US firearm fatalities in children and young adults aged 5 to 24 years that occurred between January 1, 2007, and December 31, 2016. Data were obtained from the Centers for Disease Control and Prevention's Compressed Mortality File, and annual intercensal county population data were obtained from the US Census Bureau. Data analyses were conducted between November 1, 2019, and June 30, 2020.EXPOSURES County-level poverty was categorized into 5 groups: 0% to 4.9%, 5% to 9.9%, 10% to 14.9%, 15% to 19.9%, and Ն20% of the population living below the federal poverty level. MAIN OUTCOMES AND MEASURESThe main outcomes were firearm-related deaths in total and by specific intent (homicide, suicide, and unintentional) per 100 000 youths over the entire study period. Multivariable negative binomial regression models were used to analyze the association between firearm-related mortality rates and county poverty concentration, controlling for demographic variables, urbanicity, and statewide firearm prevalence. Adjusted incidence rate ratios (IRRs) were calculated, and statewide firearm prevalence was estimated. The population-attributable fraction (PAF) and years of potential life lost for each intent were calculated.RESULTS A total of 67 905 firearm-related deaths among youth (predominantly composed of 60 164 male individuals [88.6%]) from 2007 to 2016 were analyzed. Of these deaths, 42 512 were homicides (62.6%), 23 034 were suicides (33.9%), and 1627 were unintentional (2.4%). Firearm-related mortality risk increased in a stepwise manner with increasing county poverty concentration. Compared with counties with the lowest poverty concentration, counties with the highest poverty concentration had an increased rate of total firearm-related deaths (adjusted IRR, 2.29; 95% CI, 1.96-2.67), homicides (adjusted IRR, 3.55; 95% CI, 2.80-4.51), suicides (adjusted IRR, 1.45; 95% CI, 1.20-1.75), and unintentional deaths (adjusted IRR, 9.32; 95% CI, 2.32-37.4). The PAF was 0.51 (95% CI, 0.43-0.57) for all firearm-related deaths, 0.66 (95% CI, 0.57-0.73) for homicides, 0.30 (95% CI, 0.17-0.42) for suicides, and 0.86 (95% CI, 0.46-0.97) for unintentional deaths. This calculation translated to 34 292 firearm-related deaths that would not have occurred if all counties had the same risk as counties with the lowest poverty concentration. A total of 3 833 105 years of potential life lost was observed.CONCLUSIONS AND RELEVANCE This study found an association between firearm-related mortality rates among youth and county-level poverty concentration. With more than half of firearm-related deaths and two-thirds of firearm-related homicides potentially associated wi...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Association of County-Level Poverty and Inequities With Firearm-Related Mortality in US Youth

et al. 2022

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“…However, in adjusted analyses, this age group was associated with a reduced rate of outpatient mental health service use during the postinjury period, which was a somewhat surprising finding, considering previous studies highlighting mental health issues in this group during their recovery from injury. 1,11,29 One possible explanation could be that, in our health care system, pediatric patients with mental health concerns may be more likely to be admitted for inpatient care rather than managed as an outpatient (if pediatric mental health services are biased toward an inpatient delivery model); however, our study was not designed to test this hypothesis. Additional considerations could include whether pediatric patients may be more likely to access outpatient services provided by nonphysician providers (i.e., counselors, psychologists, or social workers) covered either under OHIP or through private insurance plans and not captured in the ICES data sets.…”

Section: Discussionmentioning

confidence: 99%

Outpatient mental health service use in major trauma survivors: A population-based cohort study from Ontario, Canada

Evans¹,

Jagelavičiūtė

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:Mental health is recognized as an important outcome in major trauma survivors. There are limited data on how and when survivors access mental health services. Our objectives were to determine the frequency, timing, and factors associated with outpatient mental health service utilization in major trauma survivors. METHODS:We conducted a population-based cohort study using linked administrative data on patients treated for major trauma in Ontario between 2009 and 2017. All trauma survivors were included in the cohort, and composite rates of outpatient mental health service use (family doctor, psychiatrist, or emergency department visits) were compared in the 3 years preinjury and postinjury. We used an exposure crossover study design and negative binomial regression with generalized estimating equations for the analysis. Multivariate logistic regression analyses were used to identify patient characteristics associated with mental health service use during the follow-up period. RESULTS:There were 37,260 patients included in the cohort, predominantly men (70.8%) from urban areas (84.8%) suffering blunt trauma (89.7%). Among the patients, 47.4% used mental health services during the preinjury period and 61.8% during the postinjury period (absolute increase of 14.4%). Compared with the 3 years preinjury, the rate of mental health service use increased by 80% (rate ratio, 1.8; 95% confidence interval, 1.75-1.77) in the 3 years following injury. Most survivors (62.2%) used services within the first year following discharge. Postinjury mental health service use (adjusted odds ratio, 3.4; 95% confidence interval, 2.2-3.7) was most strongly associated with preinjury mental health service use. CONCLUSION:Preinjury and postinjury outpatient mental health service use is common in trauma patients, with preinjury service use predictive of ongoing service use. Mental health concerns should be an expected outcome of major trauma and efforts made to implement and expand access to services for injury survivors across trauma systems.

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“…Conversely, Vasan et al showed that simply being exposed to neighborhood gun violence was associated with an increase in children’s mental health–related emergency department visits. In a study of Medicaid-insured children and adolescents who experienced a firearm injury, Pulcini et al found that children and adolescents with low total health care expenditures before the injury had a substantial increase in mental health care encounters and expenditures after the injury, whereas children and adolescents with previously high mental health care expenditures had a significant drop in mental health care service utilization and expenditures after the injury.…”

Section: Introductionmentioning

confidence: 99%

Mental Health Care Utilization Among Children and Adolescents With a Firearm Injury

et al. 2023

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ImportanceFirearm injuries are a leading cause of morbidity and mortality among US children and adolescents. Despite evidence demonstrating mental health sequelae for children and adolescents who have experienced a firearm injury, little is known about mental health care utilization after a firearm injury.ObjectiveTo evaluate mental health care utilization in the 12 months after a firearm injury among Medicaid-insured and commercially insured children and adolescents compared with propensity score–matched controls.Design, Setting, and ParticipantsThis propensity score–matched retrospective cohort analysis assessed 2127 children and adolescents, aged 0 to 17 years, with a firearm injury that occurred between January 1, 2016, and December 31, 2017, compared with 2127 matched controls using MarketScan Medicaid and commercial claims data. Claims data were analyzed 12 months before and after injury, with the total study period spanning from January 1, 2015, to December 31, 2018.ExposureNonfatal firearm injury.Main Outcomes and MeasuresThe primary outcome of interest was a dichotomous variable representing any mental health care utilization in the 12 months after injury. Secondary outcomes included psychotherapy utilization, substance use–related utilization, and a psychotropic medication prescription. Logistic regression modeling was used to estimate relative risks with adjusted analyses of dichotomous outcomes.ResultsThe overall cohort consisted of 4254 children and adolescents, of whom 2127 (mean [SD] age, 13.5 [4.1] years; 1722 [81.0%] male) had an initial encounter for a firearm injury and an equal number of matched controls (mean [SD] age, 13.5 [4.1] years; 1720 [80.9%] male). Children and adolescents with a firearm injury had a 1.40 times greater risk (95% CI, 1.25-1.56; P &lt; .001) of utilizing mental health services in the 12 months after their injury compared with children and adolescents without a firearm injury, after controlling for potential confounders. Children and adolescents with a firearm injury had a 1.23 times greater risk (95% CI, 1.06-1.43; P = .007) of utilizing psychotherapy and a 1.40 times greater risk (95% CI, 1.19-1.64; P &lt; .001) of substance use–related utilization. Among those who experienced a firearm injury, Black children and adolescents were 1.64 times more likely (95% CI, 1.23-2.19; P &lt; .001) to utilize mental health care compared with White children and adolescents.Conclusions and RelevanceThis propensity score–matched cohort study found that children and adolescents with a firearm injury had a greater risk of utilizing mental health services in the 12 months after their injury compared with those without an injury, and significant racial disparities were associated with use of mental health services. The findings suggest that health care practitioners should be aware of this increased risk and ensure adequate mental health follow-up for these patients.

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Mental Health Utilization and Expenditures for Children Pre–Post Firearm Injury

Cited by 14 publications

References 5 publications

Association of County-Level Poverty and Inequities With Firearm-Related Mortality in US Youth

Association of County-Level Poverty and Inequities With Firearm-Related Mortality in US Youth

Outpatient mental health service use in major trauma survivors: A population-based cohort study from Ontario, Canada

Mental Health Care Utilization Among Children and Adolescents With a Firearm Injury

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