Each year, 20,000 children and adolescents across the U.S. lose a parent to gun violence, while an estimated two to three times more have a parent who has been injured due to a firearm.

Investigators from Harvard and Mass General Brigham analyzed records from a large health insurance database and found that in the year following a parent’s injury, children had increases in psychiatric diagnoses and mental health visits, especially if the parent had suffered a severe injury.

The findings are published in the New England Journal of Medicine.

“Firearm injury is the most common cause of death in children and adolescents, but as horrific as this fact is, it represents only one way in which gun violence impacts young people,” said lead author George Karandinos, a research investigator in the Gun Violence Prevention Center of Massachusetts General Hospital, and an instructor in medicine at Harvard Medical School. “As a physician and anthropologist who has worked in areas with concentrated gun violence, I have seen directly how individuals and communities are affected at many levels. By zooming out and using population data, our study draws attention to the way that firearm injuries reverberate through whole families, harming even those who were not injured directly.”

For this study, researchers matched the records of children who had a parent who experienced a firearm injury with records of up to five control children of the same sex, geographic region, and insurance coverage and ensured that the two groups were also closely balanced overall in terms of children’s age and health risks. In total, 3,790 youth exposed to parental firearm injury and 18,535 controls were included, with an average age of 10.7 years.

The researchers found a sharp and persistent increase in rates of psychiatric diagnoses and mental health visits following parental firearm injury in the exposed group alone. Relative to the control group, exposed youth experienced a 42 percent increase in psychiatric diagnoses and 60 percent increase in mental health visits in the year after parental firearm injury.

Mental health impacts of parental firearm injury were especially pronounced in female children and adolescents and for children with a parent whose injuries necessitated intensive-care unit treatment. Trauma/post-traumatic stress disorder diagnoses accounted for most of the increase, but mood disorders, including depression, also increased.

The researchers explained that though their work may underestimate the true mental health impact of firearm violence because it only accounts for formal diagnoses and medical visits, it can nonetheless encourage broader recognition of the need for early, targeted interventions. Hospital-based violence intervention programs and improved communication with pediatricians caring for the children of firearm-injured parents are two options for improving access to mental health care for affected children.

“The mental health need that we have documented in this work is something that can be addressed by leveraging existing programs, while also improving interdisciplinary care coordination after firearm injury,” Karandinos said. “These interventions are intuitive, but funding and supporting them is essential to truly caring for the entire family.”

This research was funded by the National Institute for Health Care Management and the MGH Gun Violence Prevention Center.