Mental Health Outcomes in Children after Parental Firearm Injury

Every year, approximately 20,000 youths lose a parent to firearm injury in the United States. Many more youths have parents who sustain nonfatal firearm injuries. The effect of parents' firearm injuries on their children's health and health care is poorly understood.

Using U.S. commercial health insurance claims data from the 2007-2022 period, we identified youths, 1 to 19 years of age, whose parents had received treatment for firearm injury (exposure). Each youth with exposure was matched with up to five control youths on the basis of year, month, youth sex, metropolitan statistical area, state, insurance plan type, and prescription drug coverage; mean values of age and a risk score predicting future health care use (to provide a proxy for health status) were balanced. The primary outcome was a diagnosis of psychiatric disorder among youths, assessed as a rate, which was defined as the number of youths with at least one related insurance claim in a given month, divided by the total number of youths. Secondary outcomes included substance use disorder diagnosis, health care use, and medical spending. After matching, we estimated the difference in differences in outcomes between the exposure group and the control group 12 months before the parental injury through 12 months after the injury, using a least-squares regression model with adjustment for age and risk score.

We examined 3790 youths with exposure and 18,535 matched controls. The mean age of the youths was 10.7 years, and 51.5% were male. Parental firearm injury was associated with 8.4 additional psychiatric diagnoses (95% confidence interval [CI], 4.8 to 12.0) per 1000 youths and 23.1 additional mental health visits (95% CI, 8.2 to 38.1) per 1000 youths as compared with control, averaged over the year. This associated increase in the exposure group was largest for diagnoses of trauma-related disorders, including post-traumatic stress disorder, with an additional 8.5 diagnoses (95% CI, 6.0 to 10.9) per 1000 youths as compared with control, averaged over the year. No apparent changes relative to control were observed in rates of other diagnoses, medical encounters, procedures, and services or in medical spending.

Parents' firearm injuries were associated with increases in rates of psychiatric disorders and mental health visits among their children. (Funded by the National Institute for Health Care Management and the National Institute of Mental Health.).