Mental Healthcare Following Firearm and Motor Vehicle Related Injuries: Differences Impacting Our Treatment Strategies


Peter F. Ehrlich, Section of Pediatric Surgery CS Mott Children's Hospital University of Michigan Ann Arbor, Michigan, USA.
Christian D. Pulcini, Department of Surgery & Pediatrics, University of Vermont Medical Center and Children's Hospital, Larner College of Medicine at the University of Vermont, Burlington, VT, USA.
Heidi G. De Souza, Children's Hospital Association, Lenexa, KS, USA.
Matt Hall, Children's Hospital Association, Lenexa, KS, USA.
Annie Andrews, Department of Pediatrics, Medical College of South Carolina, Charleston, SC, USA.
Bonnie T. Zima, UCLA-Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA.
Joel A. Fein, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
Sofia Chaudhary, Department of Pediatrics and Emergency Medicine, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.
Jennifer A. Hoffmann, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Eric W. Fleegler, Departments of Pediatrics and Emergency Medicine, Harvard Medical School; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA.
Kristyn N. Jeffries, Department of Pediatrics, Division of Hospital Medicine, Children's Mercy Hospitals, Kansas City, MO, USA.
Monika K. Goyal, Department of Pediatrics, Children's National Hospital, George Washington University, Washington, DC, USA.
Stephen Hargarten, Department of Emergency Medicine and the Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, WI, USA.
Elizabeth R. Alpern, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Document Type

Journal Article

Publication Date



Annals of surgery




OBJECTIVE: To compare new mental health diagnoses (NMHD) in children after a firearm injury versus following a motor vehicle collision (MVC). SUMMARY BACKGROUND DATA: A knowledge gap exists regarding childhood mental health diagnoses following firearm injuries, notably in comparison to other forms of traumatic injury. METHODS: We utilized Medicaid MarketScan claims (2010-2016) to conduct a matched case-control study of children ages 3-17 years. Children with firearm injuries were matched with up to three children with MVC injuries. Severity was determined by injury severity score (ISS) and emergency department (ED) disposition. We used multivariable logistic regression to measure the association of acquiring a NMHD diagnosis in the year post-injury after firearm and MVC mechanisms. RESULTS: We matched 1450 children with firearm injuries to 3691 children with MVC injuries. Compared to MVC injuries, children with firearm injuries were more likely to be black, have higher ISS, and receive hospital admission from the ED (P<0.001). The adjusted odds ratio (aOR) of NMHD diagnosis was 1.55 [95% CI 1.33,1.80] greater after firearm injuries compared to MVC injuries. The odds of a NMHD were higher among children admitted to the hospital compared to those discharged. The increased odds of NMHD after firearm injuries was driven by increases in substance-related and addictive disorders (aOR 2.08 [95% CI 1.63, 2.64]) and trauma and stressor-related disorders (aOR 2.07 [95% CI 1.55, 2.76]). CONCLUSIONS: Children were found to have 50% increased odds of having a NMHD in the year following a firearm injury as compared to MVC. Programmatic interventions are needed to address children's mental health following firearm injuries.