Addressing Firearm Violence Requires Coordination, Communication

Beginning in 2018, firearm-related injuries surpassed motor vehicle crashes as the leading cause of death from injury among children, adolescents, and young adults aged 1 to 24. The rate of firearm injuries seems to be growing especially rapidly among youth aged 15 to 19.

“We’re losing people who don’t even know who they are yet. We don’t know what we’re losing because we don’t know what they would have gone on to do,” said Layla Soliman, M.D., at APA’s Annual Meeting today.

Soliman and her colleagues urged psychiatrists to become involved in early intervention and education to mitigate the risk of firearm violence. While media attention usually focuses on mass shootings, Soliman and her co-presenters emphasized the immense damage that smaller-scale shootings inflict on individuals as well as communities. Soliman is a clinical assistant professor of psychiatry and behavioral medicine at Wake Forest University School of Medicine and a forensic psychiatrist with Atrium Health.

James Rachal, M.D., discussed some of the challenges when studying survivors of firearm violence. They are hard to reach because they often have lower economic means, he said, which can create transportation and other barriers. Survivors may also not want to participate in research due to the stigma of being a gunshot victim. Rachal is an associate professor of psychiatry and academic chair for the Department of Psychiatry at Wake Forest University School of Medicine.

He noted that gunshot wounds are associated with a high risk of developing posttraumatic stress disorder (PTSD). “However, after five years, we see a real decrease in the amount of PTSD symptoms associated with gunshot wounds, which is not surprising,” he said. With his patients, he finds that time and preventing retraumatization helps to alleviate their PTSD symptoms.

A. Britton Christmas, M.D., M.B.A., spoke about his experiences as an emergency surgeon at a trauma center, where staff have worked to prevent hospital readmissions among patients who experience firearm injuries and to address PTSD. Christmas is the trauma medical director at Atrium Health – Carolinas Medical Center and a clinical professor of surgery at Wake Forest University School of Medicine.

He and his colleagues found that 20% to 40% of their patients who were victims of firearm violence exhibited depressive and PTSD symptoms in the year following their injuries. They also found that 25% of patients who had violence-related injuries were readmitted for another such injury within three years.

The trauma center launched a hospital-based violence intervention program, which aims to prevent readmissions due to repeat gun violence injuries and to connect patients with resources they need in the community. They also partnered with the University of North Carolina at Charlotte to screen patients for PTSD risk and connect them with services.

John Rozel, M.D., M.S.L., described the phrase “left of boom,” which is commonly used in the military. It refers to the time that precedes a negative event when intervention is still possible. “Where we want to be, if at all possible, is left of boom, because when the bullets start flying, it’s too late,” he said. Rozel is a professor of psychiatry and adjunct professor of law at the University of Pittsburgh.

Though more research on firearm violence is needed, enough studies exist now to inform evidence-based policies, Rozel pointed out. Child access prevention laws, which promote responsible firearm storage and hold gun owners accountable for failing to properly store firearms, are backed by a significant amount of research. They have been shown to reduce violent crime, unintentional injuries and deaths, and suicides. Conversely, policies like concealed carry laws and “stand your ground” laws have been shown to increase violent crimes, Rozel said.

Firearm injury prevention is a complex problem, he said. “It means we’re going to have to push beyond some of our traditional tools beyond the simplistic, like high scores and logistic regression, to find better methods to explore the causes of firearm injuries and what we can do to reduce them,” he said.

Soliman pointed attendees to Counseling on Access to Lethal Means, which is a free online course for health care professionals that prepares them to talk with others about lethal means safety for suicide prevention. ■

(Image: Getty Images/iStock/IndiaUniform)