Mind over Matter: Mental Scars and Outcomes after Firearm Injury.

Abstract

Firearm injuries are associated with adverse physical and mental health outcomes. There is a paucity of data considering operative management, which is independently associated with adverse outcomes. This study aimed to evaluate outcomes in survivors of violent firearm injury compared with nonviolently injured patients. This multicenter prospective matched cohort study used trauma registries and surveys at 6 to 12 months postdischarge from November 1, 2014, to July 1, 2024, at 3 level I trauma centers. Survivors of firearm violence were propensity score matched in 1:2 ratio with nonviolently injured controls on age, sex, race, psychiatric diagnoses, injury severity score, head abbreviated injury scale, and operations. Mental health outcomes included quality of life (QOL), mental health-related QOL, and posttraumatic stress disorder symptoms. Physical health outcomes included return to work, functional limitations, chronic pain, physical health-related QOL, and readmission. One hundred thirty survivors of firearm violence were matched to 260 controls. The cohort was largely men (331; 84.9%), with a median age of 28 years (interquartile range 23 to 37). Survivors of firearm violence had lower mental health-related QOL (β -5.60, 95% CI -8.80 to -2.40, p < 0.001), increased posttraumatic stress disorder symptoms (odds ratio [OR] 2.89, 95% CI 1.84 to 4.53, p < 0.001), chronic pain (OR 2.17, 95% CI 1.38 to 3.42, p < 0.001), new functional limitations (OR 1.65, 95% CI 1.03 to 2.62, p = 0.04), and lower return to work (OR 0.62, 95% CI 0.40 to 0.96, p = 0.03). There were no significant differences in physical health-related QOL or readmissions. The long-term health burden of firearm violence may be predominantly associated with psychological, rather than physical, impacts of injury.