What’s New in Psychology?

The Long-Term Repercussions of Gunshot Injuries

Jim Windell

           Each year in this country 40,000 people are killed by firearms. In addition, an estimated 85,000 people survive firearm injuries every year.

           But what are the repercussions of the trauma that survivors of gunshot wounds experience beyond the immediate aftermath of the injury?

           A new study by investigators at Harvard Medical School was recently published in the Annals of Internal Medicine. This study is one of the first large-scale, quasi-experimental studies to examine the health and financial impact of gunshot wounds over the course of a full year. It is also one of the first studies to measure the health impact on the families of gunshot survivors.

           Most previous research of gunshot survivors has focused on the initial ER visit or hospital admission. Also, previous studies analyzing cost typically used the asking price or provider charges for care but not the actual amounts paid, which often differ significantly.

           This study compared the type and amount of medical care received and the amount of money spent on health care for 6,498 survivors of firearm injuries matched to 32,490 control participants and for 12,489 family members of gunshot survivors matched to 62,445 control participants. The sample included data from Medicare and commercial insurance claims from 2008 to 2018. The analysis included both payments from insurers and out-of-pocket expenses. The researchers analyzed survivors’ records from one year before firearm injury through one year after.

           The analysis, based on the examination of patient records over 10 years, shows that people who survive a firearm injury face greater risks of mental health disorders, substance use disorders, and pain in the year following injury. Moreover, gunshot survivors average $2,495 more in health care spending per month, compared with demographically and clinically matched peers. This latter finding, extrapolated to all gunshot survivors in the U.S., suggests that direct health care spending due to these injuries amounts to some $2.5 billion in the first year alone.

           According to lead author Zirui Song, “Our study reveals that, in addition to the obvious physical consequences of gunshot wounds, there are substantial mental health repercussions for both the survivors and their family members through a year following a shooting.” Song, an associate professor of health care policy at Harvard Medical School and a physician at Massachusetts General Hospital, added that “Understanding how firearm injuries reverberate across peoples’ lives and families provides insights that we can use to provide better care for patients.”

           The research also reveals that the immediate family members of survivors also appear to suffer indirect but tangible harms. For instance, significant others, parents, and children of gunshot survivors showed an increased risk of mental health problems, including depression, anxiety, and post-traumatic stress disorder.

           In light of these findings, the researchers say it may be prudent for doctors to screen gunshot survivors and their family members for signs of mental health problems and to be mindful of an increased risk of substance use disorders when treating pain in the wake of a shooting.

           “The heightened risk for these complications among both survivors and their families should be on clinicians’ radars, and individuals who show signs of secondary trauma should be referred for appropriate care and follow-up,” said Song, who practices primary care and inpatient medicine at Mass General.

           Song and her colleagues also suggest that given the magnitude of pain, suffering, and expense that firearm injuries can cause over both the short- and long-term that it is crucial that we take all the preventive measures we can to improve safety, at the same time as we enhance our guidelines for care in the aftermath of an injury to minimize impact on gunshot survivors and their families.

Zirui Song, José R. Zubizarreta, Mia Giuriato, Erica Paulos, Katherine A. Koh. Changes in Health Care Spending, Use, and Clinical Outcomes After Nonfatal Firearm Injuries Among Survivors and Family Members. Annals of Internal Medicine, 2022; DOI: 10.7326/M21-2812