Research shows that when a child is shot, trauma ripples through families

With every mass shooting, Americans look to one grim indicator – the number of deaths – as a measure of the devastating impact. But the damage left by gunshot wounds reverberates among survivors and families, causing mental health disorders to skyrocket and placing enormous burdens on the health care system. a new analysis of private health insurance claims.

In 2020, gunshot wounds became the leading cause of death for children and adolescents in the United States. Although the government does not systematically track non-fatal gunshot wounds, existing evidence suggests that it does two to three times as common as fatal. These wounds can be especially catastrophic in children, whose bodies are so small that the amount of tissue destroyed is greater.

“What comes after the shot is so often not talked about,” said Dr. Chana Sacks, co-director of the Gun Violence Prevention Center at Massachusetts General Hospital and author of the new study, published Monday in the journal Health Affairs . The research, which analyzed thousands of insurance claims, identifies lasting damage to families and communities.

• In families where a child died of a gunshot wound, surviving family members experienced sharp increases in psychiatric disorders, took more psychiatric medications, and made more visits to mental health professionals: fathers had a 5.3-fold increase in treatment of psychiatric disorders in the year after death; mothers had a 3.6-fold increase; and surviving siblings had a 2.3-fold increase.

• Children and teens who survive gunshot wounds become, like Dr. Sacks put it, ‘more lifelong patients’. During the year after the injury, their medical costs increased by an average of $34,884, a 17-fold increase over baseline, driven by hospitalizations, emergency room visits and home care, the study found.

• Children and adolescents who survived the most serious gunshot wounds and required treatment in an intensive care unit struggled significantly. In that group, diagnoses of pain disorders increased by 293 percent, and psychiatric disorders by 321 percent.

The study examined the medical records of 2,052 children who survived gunshots, 6,209 relatives of children who survived, and 265 relatives of children who died from gunshot wounds, comparing each with five control subjects. Because the study was based on private insurance claims, it did not reflect the experience of families who were uninsured or had public insurance.

The rising costs associated with firearm injuries are making it “increasingly an economic issue,” said Dr. Zirui Song, an associate professor at Harvard Medical School and co-author of the study. The prevalence of gunshot wounds has quadrupled in the past 12 years among the population covered by private insurance, he said.

In an article published last year in the Journal of the American Medical Association, Dr. Song puts the annual cost of firearm injuries in lost wages and medical expenses at $557 billion, or 2.6 percent of gross domestic product. The new study is the first to focus on the costs of non-fatal gunshot wounds, he said.

“The cruel reality is that when someone dies from a firearm injury, they are free in society – no more health care expenditures, no more tax dollars, no more resources used,” he said. “But actually surviving a firearm injury is quite expensive for society. How big that was was previously unknown.”

National data on nonfatal gunshot wounds is “disturbingly unreliable,” but many survivors face long-term disability, said Dr. Megan Ranney, an emergency room physician and the dean of the Yale School of Public Health, who was not involved in the study was involved.

“They may have been shot in the intestines, or through a major blood vessel, a bullet may have gone through their lungs,” said Dr. Ranney. “They may also have been shot in the head or spine.”

Trauma physicians have long observed the ripple effect of shootings on the health of family members and communities, she said, often due to repeated emergency room visits for nightmares, anxiety or depression, but “we’ve never been able to measure it. ”

Clementina Chery, a Boston woman whose 15-year-old son was fatally shot in a crossfire in 1993, and who founded the Louis D. Brown Peace Institute, an organization to support families who have lost members to gun violence, she said she has often seen survivors struggle with addictive behavior, job loss, suicidal or homicidal thoughts in the years after a young person has died.

“In that immediate aftermath, I just felt like I was having an out-of-body experience,” Ms. Chery said. She turned to alcohol, she said – “a little wine here, a little wine there” – and found it difficult to leave her house. Her marriage ended. What finally woke her up, she said, was the realization that her younger children were no longer paying attention.

“I was literally going through the motions,” she said. “I wasn’t alive. It was like, what do you call it, a mechanical robot.”

The ripple effect of gunshot wounds is important because these injuries are often concentrated in specific communities. mostly communities of color, where many young people know someone who has been shot, said Dr. Sacks.

She traced her interest in the subject to the 2012 mass shooting at Sandy Hook Elementary School in Newtown, Conn., where her cousin’s 7-year-old son was among 20 children murdered. The child’s death “changed my life” and continued to shape large families and communities in the years that followed, she said.

“We can’t look at this as a problem that starts and ends with the bullet going in and then the acute surgical care,” said Dr. Sacks. “Leaving the hospital is just the beginning of the family’s journey, and I think we should treat it that way.”