New England Journal of Medicine最新文献

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Mental Health Outcomes in Children after Parental Firearm Injury. 父母枪支伤害后儿童的心理健康状况。

IF 158.5 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

New England Journal of Medicine

Pub Date : 2026-01-29 DOI: 10.1056/nejmsa2502702

George Karandinos,Mia Giuriato,José R Zubizarreta,Katherine A Koh,Peter T Masiakos,Zirui Song,Chana A Sacks

BACKGROUNDEvery year, approximately 20,000 youths lose a parent to firearm injury in the United States. Many more youths have parents who sustain nonfatal firearm injuries. The effect of parents' firearm injuries on their children's health and health care is poorly understood.METHODSUsing U.S. commercial health insurance claims data from the 2007-2022 period, we identified youths, 1 to 19 years of age, whose parents had received treatment for firearm injury (exposure). Each youth with exposure was matched with up to five control youths on the basis of year, month, youth sex, metropolitan statistical area, state, insurance plan type, and prescription drug coverage; mean values of age and a risk score predicting future health care use (to provide a proxy for health status) were balanced. The primary outcome was a diagnosis of psychiatric disorder among youths, assessed as a rate, which was defined as the number of youths with at least one related insurance claim in a given month, divided by the total number of youths. Secondary outcomes included substance use disorder diagnosis, health care use, and medical spending. After matching, we estimated the difference in differences in outcomes between the exposure group and the control group 12 months before the parental injury through 12 months after the injury, using a least-squares regression model with adjustment for age and risk score.RESULTSWe examined 3790 youths with exposure and 18,535 matched controls. The mean age of the youths was 10.7 years, and 51.5% were male. Parental firearm injury was associated with 8.4 additional psychiatric diagnoses (95% confidence interval [CI], 4.8 to 12.0) per 1000 youths and 23.1 additional mental health visits (95% CI, 8.2 to 38.1) per 1000 youths as compared with control, averaged over the year. This associated increase in the exposure group was largest for diagnoses of trauma-related disorders, including post-traumatic stress disorder, with an additional 8.5 diagnoses (95% CI, 6.0 to 10.9) per 1000 youths as compared with control, averaged over the year. No apparent changes relative to control were observed in rates of other diagnoses, medical encounters, procedures, and services or in medical spending.CONCLUSIONSParents' firearm injuries were associated with increases in rates of psychiatric disorders and mental health visits among their children. (Funded by the National Institute for Health Care Management and the National Institute of Mental Health.).

背景：在美国，每年大约有2万名青少年因枪支伤害而失去父母。更多年轻人的父母遭受过非致命的枪伤。父母的枪支伤害对孩子的健康和医疗保健的影响知之甚少。方法使用2007-2022年期间的美国商业健康保险索赔数据，我们确定了父母因火器伤害（暴露）接受治疗的1至19岁的年轻人。根据年、月、性别、大都市统计区域、州、保险计划类型和处方药覆盖率，将每个暴露青少年与最多5名对照青少年进行匹配；年龄平均值和预测未来医疗保健使用的风险评分（提供健康状况的代理）是平衡的。主要结果是青少年中精神疾病的诊断，评估为比率，其定义为在给定月份至少有一项相关保险索赔的青少年人数除以青少年总数。次要结局包括物质使用障碍诊断、卫生保健使用和医疗支出。匹配后，我们使用最小二乘回归模型，调整年龄和风险评分，估计暴露组和对照组在父母受伤前12个月至受伤后12个月的结果差异。结果我们检查了3790名接触者和18535名匹配对照。青年平均年龄10.7岁，男性占51.5%。与对照组相比，父母火器伤害与每1000名青少年中8.4例额外的精神病学诊断（95%置信区间[CI]， 4.8至12.0）和每1000名青少年中23.1例额外的精神健康就诊（95% CI， 8.2至38.1）相关。暴露组在创伤相关疾病（包括创伤后应激障碍）诊断方面的相关增长最大，与对照组相比，每年平均每1000名青少年增加8.5例诊断（95% CI， 6.0至10.9）。在其他诊断、医疗接触、程序、服务或医疗支出方面，与对照组相比，没有明显的变化。结论父母的枪支伤害与子女精神疾病和心理健康就诊率的增加有关。（由国家卫生保健管理研究所和国家精神卫生研究所资助。）

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IF 158.5 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

New England Journal of Medicine

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