588 - Mental Health Service Use after Pediatric Nonfatal Firearm Injuries

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 588
Publication Number: 588.223

Jennifer A. Hoffmann, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Christian D.. Pulcini, University of Vermont, Burlington, VT, United States; Matt Hall, Children's Hospital Association, Lenexa, KS, United States; Heidi De Souza, Children's Hospital Association, Lenexa, KS, United States; Elizabeth Alpern, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Sofia Chaudhary, Emory University School of Medicine/Children's Healthcare of Atlanta, Decatur, GA, United States; peter ehrlich, University of Michigan Medical School, Ann Arbor, MI, United States; JOEL A. FEIN, Perelman School of Medicine at the University of Pennsylvania, Media, PA, United States; Eric Fleegler, Boston Children's Hospital, Needham, MA, United States; Monika Goyal, Children's National Health System, Washington, DC, United States; Stephen W. Hargarten, Medical College of Wisconsin, Shorewood, WI, United States; Kristyn Jeffries, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Bonnie Zima, UCLA, Los Angeles, CA, United States

Presenting Author(s)

Jennifer A. Hoffmann, MD, MS (she/her/hers)

Assistant Professor of Pediatrics
Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States

Background: Children who survive firearm injuries are at risk for adverse mental health (MH) outcomes. However, little is known about patterns of MH service use after pediatric firearm injuries.

Objective: Our objective was to examine sociodemographic and clinical characteristics associated with MH service use after a nonfatal firearm injury among Medicaid-enrolled children, and to determine how the timing of the first outpatient MH visit after injury varies by sociodemographic and clinical characteristics.

Design/Methods: We retrospectively studied children 5-17 years with nonfatal firearm injuries from 2010-2018 in the Medicaid MarketScan claims database. We used regression analyses to examine characteristics associated with MH service use in the 6 months after injury. We used Cox proportional hazards multivariable models to assess variation in time to first outpatient MH visit, adjusted for sociodemographic and clinical characteristics, among all injured children and in the subgroup without prior MH service use.

Results: Among 2613 children with a nonfatal firearm injury, 958 (36.7%) used any MH services in the 6 months after injury, and, of these, 378 (39.5%) had new MH service use. The most frequent new MH diagnoses were substance-related/addictive disorders and trauma/stressor-related disorders. The odds of MH service use after injury was higher among children with prior MH service use (aOR 10.41, 95% CI 8.45, 12.82), children with a new MH diagnosis during the index firearm encounter (aOR 3.07, 95% CI 2.34, 4.02), children with a new complex chronic condition after injury (aOR 1.99, 95% CI 1.36, 2.92), and among non-Hispanic White children (aOR 1.29, 95% CI 1.02, 1.63) compared with non-Hispanic Black children. Of 887 children with a MH outpatient visit in the 6 months after injury, 488 (55%) had a visit within 1 month of injury. Children with prior MH service use had a shorter time to first MH outpatient visit after injury (aHR 6.30, 95% CI 5.44, 7.30) (Figure 1). Of children without prior MH service use, the time to first MH outpatient visit was shorter for children with a MH diagnosis made during the index firearm injury encounter (aHR 2.73, 95% CI 2.04, 3.65) and for children with a new complex chronic condition after injury (aHR 1.66, 95% CI 1.14, 2.42).

Conclusion(s): Our findings suggest a need to prioritize access to MH services after a firearm injury for children who are Black and who have no prior MH service contact. Detection of new MH diagnoses during a firearm injury encounter may facilitate more timely connection to subsequent MH services.