Nearly half of US gun violence survivors suffer from PTSD even a decade after being shot, says study
Survivors of gunshot wounds experience adverse mental and physical problems - even a decade after being shot - which includes post-traumatic stress disorder (PTSD) and substance abuse.
According to the research team, which studied 183 gunshot wound survivors in the US, the findings reveal that the effects of gun violence extend beyond the standard outcome measures of death and economic burden.
The study participants were patients at an urban trauma center and were surveyed by telephone up to 10 years following injury. The researchers say that the young adult patients (median age, 27 years) - who survived gunshot wounds (median time from injury, 5.9 years) - scored lower on measures of physical health and mental health compared with the general population.
Compared to before being shot, gunshot wound survivors had increased unemployment and alcohol and substance use, and nearly half (48.6%) screened positive for probable post-traumatic stress disorder. Unemployment rates increased by 14.3% after injury, with overall combined alcohol and substance use rising by 13.2%, according to the analysis published in JAMA Surgery.
“In the present study, we found that survivors of gunshot wounds experience adverse physical and mental function outcomes years after being shot. Moreover, these consequences do not appear to improve with time nor are they limited to those with critical injuries requiring hospital or ICU admission”, say researchers from the University of Pennsylvania, Philadelphia, and University of Rochester Medical Center, Rochester. 
According to the researchers, while there has been increasing awareness of the devastating effects of gun violence, a lot of focus is on gun-related deaths, and people sometimes tend to forget the survivors. They explain while common outcome measures of mortality and economic burden are important, they do not capture long-term outcomes in these patients, most of whom are young. This has a lot of implications on their long-term quality of life and loss of income, among others.
“The analysis shows that gunshot wound injuries are intensely traumatic and stressful for survivors. Also important, 33.3% of our study participants with seemingly minor physical injuries - who were discharged from the emergency department - had screen findings for probable PTSD”, says the team.
Based on the results of this cohort study, the researchers have implemented a program in the trauma clinic at the University of Pennsylvania to prospectively identify and follow up survivors of firearm injury.
The effects of firearm violence in the US have been devastating: 462,043 Americans were killed by firearms from 1999 to 2013, says the study. The gun-related homicide rate in the US, according to researchers, is 25 times higher than in other high-income countries and appears to be increasing.
In 2017, the Centers for Disease Control and Prevention (CDC) reported that US firearm-related homicides reached their highest peak since tracking of these data began 40 years ago. “The mean initial hospitalization costs related to firearm injuries are estimated at $735 million per year, with an increasing burden placed on taxpayers”, says the team.
In the current study, researchers examined patient-reported outcomes among gunshot wound survivors from January 1, 2008, through December 31, 2017, at a single urban level I trauma center.
“Attempts were made to contact all adult patients (aged 18 years) discharged alive during the study period. A total of 3088 patients were identified: 516 (16.7%) who died during hospitalization, and 45 (1.5%) who died after discharge were excluded. Telephone contact was made with 263 (10.4%) of the remaining patients, and 80 (30.4%) declined study participation. The final study sample consisted of 183 participants. Data were analyzed from June 1, 2018, through June 20, 2019”, says the study.
The study group included 169 men and 14 women. Overall, a significant number of participants reported worse outcomes compared with the US general population (122 of 181 or 67.4%). This includes the domains of physical function (118 of 183 or 64.5%), emotional support (58 of 183 or 31.7%), as well as the ability to participate in social roles and activities (85 of 183 or 46.4%).
“When compared with their respective reference populations, participants also reported worse scores in pain intensity (86 of 183 or 47%), alcohol use (14 of 64 or 21.9%), and severity of substance use (6 of 24 or 25%) domains. Eighty-nine of the 148 participants (56.1%) who considered their gunshot wound a traumatic event had screen findings for probable PTSD (48.6% of the overall population)”, the findings state.
The study, according to researchers, shows that a deeper understanding of the long-term outcomes of firearm injuries is needed to provide more appropriate and tailored care to this unique patient population. The experts say there should be a better way to capture these patients from the time of injury, ensure open lines of communication, as well as reliable contact information and figure out the best way to manage their physical and mental health.
“This study’s results suggest that the lasting effects of firearm injury reach far beyond mortality and economic burden. Survivors of gunshot wounds may have negative outcomes for years after injury. These findings suggest that early identification and initiation of long-term longitudinal care is paramount", says the team.