Timing of Mental Health Service Use After a Pediatric Firearm Injury

Violent crime victimization and mental health among adolescents in Mexico

Objectives

To understand the association between violent crime victimization and mental health outcomes among adolescents in Mexico, and to define the link between the nominal classification of violent crime and mental health outcomes.

Methods

We used fixed-effects linear and logistic regressions and survey data from the 2018-2019, 2021, 2022, and 2023 National Health and Nutrition Survey (n = 26,187). Survey waves were conducted in all 32 Mexican states during: July 2018-June 2019, July-December 2021, July-December 2022, and July-October 2023.

Results

Violent crime victimization was associated with higher scores of having depressive symptoms (CESD-7) (b = 1.93 points, ± 0.26), and greater likelihood of suicidal ideation (adjusted odds ratio (aOR) = 5.32, ± 0.86) and suicide attempts in the last twelve months (aOR = 6.87, ± 2.74). More serious classes of violent crime relate to worse mental health outcomes among adolescents. Specifically, kidnapping, the most serious class of violent crime in our data, correlates with worse mental health outcomes when compared to robbery or aggravated assault.

Conclusions

Violent crime victimization is linked to increased depressive symptoms, suicidal ideation, and suicide attempts among adolescents. More serious classes of violent crime are associated with worse mental health outcomes in this population.

Mental health sequelae of violent injury in children: a review

In the last decade, increasing attention has been paid to the magnitude and characterization of the relationship between violent injury and mental health, with trauma centers progressively focusing on screening and intervention strategies. This review aims to characterize the mental health sequelae of violent injury on children, highlighting effective screening and intervention tools. Violent injury compared to non-violent injury incurs a greater risk for poor mental health outcomes. Risk of acute stress disorder and post-traumatic stress disorder are among the best characterized, but anxiety, depression, and substance use disorders are also correlated to violent injury in children. Mental health sequelae are pervasive, and have lasting, significant physical and psychosocial consequences. Globally, the impact of mental health sequelae of violent injury is underrecognized and undertreated. Provider awareness, and early and efficacious screening can facilitate tailored intervention strategies.

Childhood Exposure to Firearm Violence in Chicago and Its Impact on Mental Health

OBJECTIVE

To describe how often Chicago children are exposed to firearm violence, the types of exposure, and the parent-reported impact of these exposures on child mental health symptoms.

METHODS

Data were collected in May-July 2022 using the Voices of Child Health in Chicago Parent Panel Survey, administered to parents with children aged 2-17 years from all 77 Chicago neighborhoods. Firearm violence exposure was characterized as indirect (hearing gunshots or knowing someone who was shot) or direct (witnessing a shooting, being threatened with a firearm, being shot at but not injured, or being shot and injured). Parents indicated if children in their household had any of the following mental health symptoms associated with firearm violence exposure: fear, anxiety, sadness, isolation, difficulty concentrating, difficulty in school, or aggression. Chi-squared tests and multivariable logistic regression models were used for statistical analysis.

RESULTS

Responses were received from 989 Chicago parents. More than one third (37%) of children were exposed to firearm violence with an indirect exposure prevalence of 32% and a direct exposure prevalence of 10%. Mental health symptoms associated with firearm violence exposure were reported for 20% of children. Mental health symptoms were reported for 7% of children without firearm violence exposure compared to 31% with indirect exposure (aOR 6.2, 95% CI: 3.7, 10.6) and 68% with direct exposure (aOR 36.1, 95% CI: 16.6, 78.6) CONCLUSIONS: Chicago children with indirect and direct exposure to firearm violence had more parent-reported mental health symptoms than unexposed children. Trauma informed care approaches to mitigate the negative mental health effects of both direct and indirect firearm violence exposure are critical.

Engagement With Mental Health Services Among Survivors of Firearm Injury

Importance

Despite the prevalence of posttraumatic stress symptoms after firearm injury, little is known about how firearm injury survivors connect with mental health services.

Objective

To determine facilitators and barriers to mental health care engagement among firearm injury survivors.

Design, Setting, and Participants

A 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 Measures

Survivors' lived experience after firearm injury, sources of emotional support, mental health utilization, and their desired engagement with mental health care after firearm injury.

Results

A 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 Relevance

In 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.