Recent, Nearby Gun Violence and Recurrent Psychiatric Exacerbation in Children and Adolescents

Importance: Gun violence and youth mental illness are urgent public health concerns. Although prior studies have linked community violence with pediatric mental health outcomes, little is known about the connection between exposure to hyperlocal gun violence and the short-term risk of a psychiatric emergency at the individual level. Objective: To estimate the impact of recent, nearby gun violence exposure on pediatric recurrent psychiatric exacerbation risk following an index psychiatric hospital admission or emergency department (ED) visit. Design: Retrospective longitudinal cohort study using survival analyses with Cox proportional hazards models adjusted for season and census tract-level community deprivation and chronic crime. Participants: Children and adolescents <18 years of age with a psychiatric hospital admission or ED visit at Cincinnati Children's between January 1, 2016, and December 31, 2024, and a geocoded residential address within Cincinnati, Ohio. Exposure(s): Recent, nearby gun violence, defined as at least one incident occurring within 400 meters of a patient's geocoded residential addresses during the preceding 14 days. Main Outcome(s) and Measure(s): Recurrent psychiatric exacerbation, defined as a subsequent psychiatric hospital admission or ED visit after an index exacerbation encounter. Results: Among 4,730 children and adolescents (median age 13.7 years; [IQR, 10.6- 15.7]; 54.1% female; 68.0% Black), participants contributed 2.1 million person-days of follow-up (median, 225 days [IQR, 38-654]). A total of 1,622 (34.3%) participants experienced a recurrent psychiatric exacerbation. Nearly half (41.5%) of participants were exposed to at least one nearby gun violence incident during follow-up. Exposure to gun violence within 400 meters of their home during the prior 14 days was associated with a higher hazard of recurrent psychiatric exacerbation in unadjusted (hazard ratio [HR], 2.26; 95% CI, 1.76-2.89) and adjusted (HR, 2.45; 95% CI, 1.91-3.14) models. Findings were robust across alternative spatial and temporal exposure definitions. Conclusions and Relevance: Among youth with prior psychiatric emergency utilization, exposure to recent nearby gun violence was associated with a substantially increased risk of recurrent psychiatric exacerbation. Gun violence may represent an acute environmental trigger of psychiatric crises and a potentially actionable target for interventions to support vulnerable youth.