Timing of Mental Health Service Use After a Pediatric Firearm Injury

Author:

Hoffmann Jennifer A.1,Pulcini Christian D.2,Hall Matt3,De Souza Heidi G.3,Alpern Elizabeth R.1,Chaudhary Sofia4,Ehrlich Peter F.5,Fein Joel A.6,Fleegler Eric W.7,Goyal Monika K.8,Hargarten Stephen9,Jeffries Kristyn N.10,Zima Bonnie T.11

Affiliation:

1. aDepartment of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois

2. bDepartment of Emergency Medicine & Pediatrics, University of Vermont Medical Center and Children’s Hospital, University of Vermont Larner College of Medicine, Burlington, Vermont

3. cChildren’s Hospital Association, Lenexa, Kansas

4. dDepartment of Pediatrics and Emergency Medicine, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia

5. eSection of Pediatric Surgery, CS Mott Children’s Hospital University of Michigan, Ann Arbor, Michigan

6. fDepartment of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania

7. gDepartments of Pediatrics and Emergency Medicine, Harvard Medical School, Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts

8. hDepartment of Pediatrics, Children’s National Hospital, George Washington University, Washington, District of Columbia

9. iDepartment of Emergency Medicine, Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, Wisconsin

10. jDepartment of Pediatrics, Section of Hospital Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas

11. kUCLA-Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California

Abstract

OBJECTIVES To examine how timing of the first outpatient mental health (MH) visit after a pediatric firearm injury varies by sociodemographic and clinical characteristics. METHODS We retrospectively studied children aged 5 to 17 years with a nonfatal firearm injury from 2010 to 2018 using the IBM Watson MarketScan Medicaid database. Logistic regression estimated the odds of MH service use in the 6 months after injury, adjusted for sociodemographic and clinical characteristics. Cox proportional hazard models, stratified by previous MH service use, evaluated variation in timing of the first outpatient MH visit by sociodemographic and clinical characteristics. RESULTS After a firearm injury, 958 of 2613 (36.7%) children used MH services within 6 months; of these, 378 of 958 (39.5%) had no previous MH service use. The adjusted odds of MH service use after injury were higher among children with previous MH service use (adjusted odds ratio, 10.41; 95% confidence interval [CI], 8.45–12.82) and among non-Hispanic white compared with non-Hispanic Black children (adjusted odds ratio, 1.29; 95% CI, 1.02–1.63). The first outpatient MH visit after injury occurred sooner among children with previous MH service use (adjusted hazard ratio, 6.32; 95% CI, 5.45–7.32). For children without previous MH service use, the first MH outpatient visit occurred sooner among children with an MH diagnosis made during the injury encounter (adjusted hazard ratio, 2.72; 95% CI, 2.04–3.65). CONCLUSIONS More than 3 in 5 children do not receive MH services after firearm injury. Previous engagement with MH services and new detection of MH diagnoses during firearm injury encounters may facilitate timelier connection to MH services after injury.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

Reference56 articles.

1. Centers for Disease Control and Prevention . WISQARS–web-based injury statistics query and reporting system. Available at: https://www.cdc.gov/injury/wisqars/index.html. Accessed August 9, 2021

2. crossing lines–a change in the leading cause of death among US children;Lee;N Engl J Med,2022

3. Childhood firearm injuries in the United States;Fowler;Pediatrics,2017

4. What are the long-term consequences of youth exposure to firearm injury, and how do we prevent them? A scoping review;Ranney;J Behav Med,2019

5. Mental health care utilization among children and adolescents with a firearm injury;Oddo;JAMA Surg,2023

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