The Hidden Burden of Mental Health Outcomes Following Firearm-related Injures : Annals of Surgery

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The Hidden Burden of Mental Health Outcomes Following Firearm-related Injures

Joseph, Bellal MD∗,⊠; Hanna, Kamil MD; Callcut, Rachael A. MD; Coleman, Jamie J. MD; Sakran, Joseph V. MD§; Neumayer, Leigh A. MD

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Annals of Surgery 270(4):p 593-601, October 2019. | DOI: 10.1097/SLA.0000000000003473



Examine the effect of different types of firearms on readmission due to acute stress disorder (ASD) and/or post-traumatic stress disorder (PTSD) in firearm-injury victims.


Survivors of firearm-related injuries suffer long-term sequelae such as disability, work loss, and deterioration in the quality of life. There is a paucity of data describing the long-term mental health outcomes in these patients.


We performed a 5-year (2011–2015) analysis of the Nationwide Readmission Database. All adult patients with firearm injuries were stratified into 3 groups by firearm type: handgun, shotgun, and semiautomatic rifle. Outcome measures were the incidence and predictors of ASD/PTSD.


A total of 100,704 victims of firearm-related injuries were identified, of which 13.3% (n = 13,393) were readmitted within 6 months of index hospitalization, 6.7% (n = 8970) of these due to ASD/PTSD. Mean age was 34 ± 14 years, 88% were men. Of those readmitted due to ASD/PTSD, 24% (n = 2153) sustained a handgun-related injury on index hospitalization, 12% (n = 1076) shotgun, and 64% (n = 5741) semiautomatic gun (P = 0.039). On regression analysis, semiautomatic gun and shotgun victims had higher odds of developing ASD/PTSD upon readmission [odds ratio (OR): 2.05 (1.10–4.12) and OR: 1.41 (1.08–2.11)] compared to handgun. Female sex [OR: 1.79 (1.05–3.05)] and younger age representing those younger than 25 years [OR: 4.66 (1.12–6.74)] were also independently associated with higher odds of ASD/PTSD.


Apart from the lives lost, survivors of semiautomatic rifle- and shotgun-related injuries suffer long-term mental health sequalae. These secondary and debilitating mental health outcomes are important considerations for capturing the overall burden of the disease.

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