Mental Health Care Following Firearm and Motor Vehicle-related Injuries: Differences Impacting Our Treatment Strategies.
Mental Health Care Following Firearm and Motor Vehicle-related Injuries: Differences Impacting Our Treatment Strategies.
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DOI：
10.1097/sla.0000000000005557
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发表时间：
2022-09-01
影响因子：
9
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比较儿童在枪伤后与机动车辆碰撞 (MVC) 后的新心理健康诊断 (NMHD)。关于枪伤后的儿童心理健康诊断存在知识差距，特别是与其他形式的创伤性伤害相比。我们利用 Medicaid MarketScan 索赔（2010-2016 年）对 3-17 岁儿童进行匹配的病例对照研究。枪伤儿童与最多三名 MVC 受伤儿童进行匹配。严重程度由伤害严重程度评分 (ISS) 和急诊科 (ED) 处理决定。我们使用多变量逻辑回归来衡量在枪械和 MVC 机制受伤后一年内获得 NMHD 诊断的关联。我们将 1450 名遭受枪伤的儿童与 3691 名遭受 MVC 伤害的儿童进行了匹配。与 MVC 伤害相比，遭受枪伤的儿童更有可能是黑人、具有更高的 ISS 并从急诊室入院 (p<0.001)。与 MVC 损伤相比，枪伤后 NMHD 诊断的调整优势比 (aOR) 高 1.55 [95% CI 1.33,1.80]。与出院儿童相比，入院儿童患 NMHD 的几率更高。枪伤后发生 NMHD 的几率增加是由于物质相关和成瘾性疾病 (aOR 2.08 [95% CI 1.63, 2.64]) 以及创伤和压力源相关疾病 (aOR 2.07 [95% CI 1.55, 2.76]) 的增加所致。研究发现，与 MVC 相比，儿童在枪伤后一年内患 NMHD 的几率增加了 50%。需要有计划的干预措施来解决枪伤后儿童的心理健康问题。我们通过病例对照设计比较了枪伤和机动车碰撞后儿童的新心理健康诊断。我们发现，遭受枪伤的儿童获得新的心理健康诊断的几率是机动车碰撞儿童的 1.5 倍。
To compare new mental health diagnoses (NMHD) in children after a firearm injury versus following a motor vehicle collision (MVC). A knowledge gap exists regarding childhood mental health diagnoses following firearm injuries, notably in comparison to other forms of traumatic injury. We utilized Medicaid MarketScan claims (2010–2016) to conduct a matched case-control study of children ages 3–17 years. Children with firearm injuries were matched with up to three children with MVC injuries. Severity was determined by injury severity score (ISS) and emergency department (ED) disposition. We used multivariable logistic regression to measure the association of acquiring a NMHD diagnosis in the year post-injury after firearm and MVC mechanisms. We matched 1450 children with firearm injuries to 3691 children with MVC injuries. Compared to MVC injuries, children with firearm injuries were more likely to be black, have higher ISS, and receive hospital admission from the ED (p<0.001). The adjusted odds ratio (aOR) of NMHD diagnosis was 1.55 [95% CI 1.33,1.80] greater after firearm injuries compared to MVC injuries. The odds of a NMHD were higher among children admitted to the hospital compared to those discharged. The increased odds of NMHD after firearm injuries was driven by increases in substance-related and addictive disorders (aOR 2.08 [95% CI 1.63, 2.64]) and trauma and stressor-related disorders (aOR 2.07 [95% CI 1.55, 2.76]). Children were found to have 50% increased odds of having a NMHD in the year following a firearm injury as compared to MVC. Programmatic interventions are needed to address children’s mental health following firearm injuries. We compared new mental health diagnoses in children after a firearm injury versus a motor vehicle collision through a case-control design. We found that children who suffered a firearm injury had 1.5 times the odds of having a new mental health diagnosis compared to children following a motor vehicle collision.