Psychosocial Risk Factors Associated With Facial Self-Inflicted and Assault-Related Gunshot Wounds at A Southeastern Level 1 Trauma Center.

Abstract

Firearm injuries are a leading cause of death in the United States. Few studies have examined psychiatric and social risk factors associated with facial self-inflicted gunshot wounds (SIGSWs) and assault-related gunshot wounds (AGSWs) in regions with high levels of firearm-related violence. This study aimed to identify factors associated with injury intent and mortality in a regional Level 1 trauma center serving the Southeastern United States. We conducted a retrospective medical record review of individuals presenting to Vanderbilt University Medical Center Emergency Department with facial gunshot wounds from 2017 to 2024 (N=409). Multivariable logistic regression models were used to assess predictors of injury intent (self-inflicted vs. assault-related) and mortality. False discovery rate (FDR) correction was applied to correct for multiple comparisons. Mortality was higher among self-inflicted injuries when compared with assault-related injuries (48.7% vs. 21.0%, P<0.001). In adjusted analyses (n=321), self-inflicted injury was associated with higher odds of mortality (aOR=5.19, 95% CI: 3.06-9.02, FDR-adjusted P<0.001). Any prior psychiatric diagnosis (aOR=0.24, 95% CI: 0.12-0.45, FDR-adjusted P<0.001) and uninsured status (aOR=0.38 (0.19 to 0.72), FDR-adjusted P=0.0139) were associated with lower odds of self-inflicted injury. A significant interaction between injury intent and sex was observed (P=0.002), with a larger mortality difference between self-inflicted and assault-related injuries among females than males. Individuals with facial SIGSWs and AGSWs demonstrate distinct clinical and psychosocial profiles, and psychiatric history and insurance status reflect other important dimensions of risk and health care engagement. These findings may inform targeted screening, prevention strategies, and postinjury care for individuals at risk of facial firearm injury. Future research should incorporate substance use and acute mental status at the time of injury to further clarify risk and outcomes.