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Original Investigation
September 20, 2021

Association of Neighborhood Gun Violence With Mental Health–Related Pediatric Emergency Department Utilization

Author Affiliations
  • 1National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 2Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 3PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 4Division of Emergency Medicine, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 5Center for Violence Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 6The Urban Health Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 7Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 8Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
JAMA Pediatr. Published online September 20, 2021. doi:10.1001/jamapediatrics.2021.3512
Key Points

Question  Is neighborhood gun violence exposure associated with children’s mental health–related pediatric emergency department (ED) utilization?

Findings  In this cross-sectional study of 54 341 children, pediatric ED utilization was compared before and after episodes of neighborhood gun violence. Among children living within 2 to 3 blocks of a shooting, increased mental health–related ED utilization was found at 2 weeks, 1 month, and 2 months after the shooting.

Meaning  Exposure to gun violence is associated with an increase in children’s acute mental health symptoms, suggesting that trauma-informed care must be prioritized in communities with a high prevalence of violence exposure, and public policies that reduce neighborhood gun violence are urgently needed.

Abstract

Importance  Many children and adolescents in the United States are exposed to neighborhood gun violence. Associations between violence exposure and children’s short-term mental health are not well understood.

Objective  To examine the association between neighborhood gun violence and subsequent mental health–related pediatric emergency department (ED) utilization.

Design, Setting, and Participants  This location-based cross-sectional study included 128 683 ED encounters for children aged 0 to 19 years living in 12 zip codes in Philadelphia, Pennsylvania, who presented to an urban academic pediatric ED from January 1, 2014, to December 31, 2018. Children were included if they (1) had 1 or more ED visits in the 60 days before or after a neighborhood shooting and (2) lived within a quarter-mile radius of the location where this shooting occurred. Analysis began August 2020 and ended May 2021.

Exposure  Neighborhood violence exposure, as measured by whether a patient resided near 1 or more episodes of police-reported gun violence.

Main Outcomes and Measures  ED encounters for a mental health–related chief complaint or primary diagnosis.

Results  A total of 2629 people were shot in the study area between 2014 and 2018, and 54 341 children living nearby had 1 or more ED visits within 60 days of a shooting. The majority of these children were Black (45 946 [84.5%]) and were insured by Medicaid (42 480 [78.1%]). After adjusting for age, sex, race and ethnicity, median household income by zip code, and insurance, children residing within one-eighth of a mile (2-3 blocks) of a shooting had greater odds of mental health–related ED presentations in the subsequent 14 days (adjusted odds ratio, 1.86 [95% CI, 1.20-2.88]), 30 days (adjusted odds ratio, 1.49 [95% CI, 1.11-2.03]), and 60 days (adjusted odds ratio, 1.35 [95% CI, 1.06-1.72]).

Conclusions and Relevance  Exposure to neighborhood gun violence is associated with an increase in children’s acute mental health symptoms. City health departments and pediatric health care systems should work together to provide community-based support for children and families exposed to violence and trauma-informed care for the subset of these children who subsequently present to the ED. Policies aimed at reducing children’s exposure to neighborhood gun violence and mitigating the mental symptoms associated with gun violence exposure must be a public health priority.

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